Recovery of an injured corticofugal tract from the supplementary motor area in a patient with traumatic brain injury: A case report.

Abstract

RATIONALE:

We report on a patient with traumatic brain injury who showed motor recovery concurrent with recovery of injured corticofugal tracts (CFTs), diagnosed by diffusion tensor tractography (DTT).

PATIENT CONCERNS:

Four weeks after onset, when the patient started rehabilitation, he showed severe weakness of both upper and lower extremities [Motricity Index (MI, full score: 100/100): 9/30].

DIAGNOSES:

A 29-year-old male patient underwent conservative management for traumatic hemorrhages in both frontal lobes and right thalamus resulting from a car accident.

INTERVENTIONS:

The patient participated in a comprehensive rehabilitative management program, including movement therapy, dopaminergic drugs for improvement of apraxia (pramipexole: 2.5mg, amantadine: 300mg, ropinirole: 0.75 mg, and levodopa: 500mg), and neuromuscular electrical stimulation therapy of the right elbow extensors, finger extensors, both knee extensors, and ankle dorsiflexors.

OUTCOMES:

After 2 months' intensive rehabilitation, his motor weakness rapidly recovered to the point that he was able to move all 4 extremities against some resistance (MI: 75/75). The right supplementary motor area (SMA)-CFT showed narrowing and partial tearing in the upper portion on 1-month DTT, and became thicker on 3-month DTT. Compared to the 12 normal control subjects, the fractional anisotropy (FA) values of the right corticospinal tract and both dorsal premotor cortex-CFT were more than 1 standard deviation lower than those of normal control subjects on both 1- and 3-month DTTs.

LESSONS:

Although the tract volume of the right SMA-CFT was more than 1 standard deviation lower than normal control subjects on 1-month DTT, it increased to within 1 standard deviation on 3-month DTT. Recovery of the injured SMA-CFT concurrent with motor recovery was demonstrated in a patient with traumatic brain injury.

• Authors: Sung Ho Jang, Seong Ho Kim, Jeong Pyo Seo
• Journal: Medicine (Medicine (Baltimore)) Vol. 97 Issue 7 Pg. e9063 (Feb 2018) ISSN: 1536-5964 [Electronic] United States
• PMID: 29443731 (Publication Type: Case Reports, Journal Article)

Topics

• Accidents, Traffic
• Adult
• Brain Injuries, Traumatic (etiology, physiopathology, rehabilitation)
• Diffusion Tensor Imaging
• Humans
• Male
• Motor Cortex (injuries, physiopathology)
• Pyramidal Tracts (injuries, physiopathology)
• Recovery of Function