Disclosures: Gregory K. Cox, MD: No financial relationships or conflicts of interest

Case Diagnosis: Bilateral Supplementary Motor Area (SMA) Syndrome After Resection of Parafalcine Meningioma

Case Description or Program Description: The patient presented to Neurology clinic with chronic back pain, shuffling gait, balance problems and urge incontinence. He underwent MRI of the lumbar spine, which was negative for significant stenosis. MRI of the brain showed an enhancing parafalcine extra-axial mass consistent with meningioma, measuring 4.9 x 6.0 x 4.6 cm with mass effect on the bilateral precentral gyrus. He underwent bifrontal craniotomy for resection of the mass. Post operatively he was found to have 0/5 strength in bilateral lower extremities, compared to 4/5 strength preoperatively. He was also noted to have acute worsening of urinary retention requiring foley placement and bowel incontinence. He was transferred to acute inpatient rehabilitation. In addition to therapies, started carbidopa/levodopa to aid motor recovery.

Setting: Hospital

Assessment/Results: After one month of rehabilitation, the patient was discharged to skilled nursing facility with modest motor recovery in his lower extremities. Notably he was antigravity with hip abduction on his right side and had 2/5 strength for knee flexion/extension. He was discharged with a motorized wheelchair and scheduled for follow up with the neurorehabilitation clinic to evaluate for continued recovery, but patient was lost to follow up.

Discussion (relevance): Supplementary motor area syndrome can occur as a complication of neurosurgery and typically presents with unilateral weakness. In the majority of cases, there is complete resolution of symptoms over weeks to months. Bilateral SMA syndrome is rare and recovery potential is sparsely described in the available literature.

Conclusions: Supplementary motor area syndrome should be considered when evaluating weakness following neurosurgical intervention, as the pattern of recovery differs significantly from direct corticospinal tract injury. This case helps characterize the process of neurologic recovery for bilateral supplementary motor syndrome.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bilateral-supplementary-motor-area-sma-syndrome-after-resection-of-parafalcine-meningioma-a-case-report/