J Korean Phys Ther.  2021 Dec;33(6):304-306. 10.18857/jkpt.2021.33.6.304.

Mild Bradykinesia Due to an Injury of Corticofugal-Tract from Secondary Motor Area in a Patient with Traumatic Brain Injury

• Lee HD
• Seo JP

• KMID: 2526449
• DOI: http://doi.org/10.18857/jkpt.2021.33.6.304

Abstract

Objectives
We report on a patient who showed mild bradykinesia due to injury of the corticofugal tract (CFT) from the secondary motor area following direct head trauma, which was demonstrated on diffusion tensor tractography (DTT).
Case summary
A 58-year-old male patient underwent conservative management for subarachnoid hemorrhages caused by direct head trauma resulting from a fall from six-meter height at the department of neurosurgery of a local hospital. His Glasgow Coma Scale score was 3. He developed mildly slow movements following the head trauma and visited the rehabilitation department of a university hospital at ten weeks after the fall. The patient exhibited mild bradykinesia during walking and arm movements with mild weakness in all four extremities (G/G - ).
Results
On ten-week DTT, narrowing of the right CFT from the supplementary motor area (SMA-CFT), and partial tearing of the left SMA-CFT, left CFTs from the dorsal premotor cortex (dPMC-CFT) and both corticospinal tracts (CSTs) at the subcortical white matter were observed.
Conclusion
This case demonstrated abnormalities in both CSTs (partial tearing at the subcortical white matter and narrowing), both SMA-CFTs (narrowing and partial tearing) and left dPMC-CFT. We believe our findings suggest the necessity of assessment of the CFTs from the secondary motor area for patients with unexplained bradykinesia following direct head trauma.

Keyword

Corticofugal tract; Diffusion tensor tractography; Bradykinesia; Direct head trauma