Disclosures: David H. Blumeyer, MD: No financial relationships or conflicts of interest

Case Description: A 39-year old male who suffered hemorrhagic stroke involving the left post central gyrus presented with deficits in fine motor control in bilateral upper extremities. Ideomotor and ideational apraxias were ruled out as the patient was able to perform pantomimes, mimic the movements of the examiner, and conceptualize tasks with the upper extremity. The patient received conventional PT and OT in the acute inpatient rehabilitation program. Initially, the patient had severe deficits in ADLs and ambulation. At discharge the patient achieved modified independence to independent level in basic activities of daily living and ambulation.

Setting: Rancho Los Amigos National Rehabilitation Center

Patient: 39 year old male with bilateral Limb-Kinetic apraxia secondary to unilateral intracerebral hemorrhage in the left post central gyrus Assessment/

Results: At three month follow-up visit, the patient maintained independence in ADLs and modified independence in ambulation.

Discussion: Studies have shown limb-kinetic apraxia to be found in neurodegenerative diseases such as Corticobasal degeneration and Parkinson’s, it is rarely found in focal brain lesions. When seen it typically presents unilaterally. The left hemisphere is considered to be the center for control of skilled movements bilaterally. The neural substrate for dexterity of the hand is considered to be the premotor and primary motor cortices. Cerebral hemorrhage in that region might have impaired the function of the primary motor cortex without causing weakness. Alternatively, the lesion subcortically extended anteriorly to the left medial frontal region, combined with the surrounding edema this could have hindered the network between the primary and the secondary motor areas leading to the patient’s bilateral presentation.

Conclusion: This case illustrates a rare case of bilateral limb-kinetic apraxia from a focal brain lesion. While the beneficial effect of rehabilitation in apraxia is controversial this case demonstrates a patient who responded very well to general inpatient rehabilitation and continued to maintain functional gains at followup.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/limb-kinetic-apraxia-following-post-central-gyrus-hemorrhage-a-case-report/