Poster 315: Callosal Apraxia Without Callosal Lesion Following Multiple Embolic Infarcts in the Anterior Cerebral Artery Distribution: A Case Report

Abstract

Poster 315 Callosal Apraxia Without Callosal Lesion Following Multiple Embolic Infarcts in the Anterior Cerebral Artery Distribution: A Case Report. Thomas S. Savadove, MD (Temple University/Moss Rehab, Philadelphia, PA); Ming K. Hsieh, MD. Disclosure: T.S. Savadove, None; M.K. Hsieh, None. Setting: Stroke unit in acute rehabilitation hospital. Patient: A 56-year-old woman with multiple bilateral anterior cerebral artery (ACA) infarcts. Case Description: The patient presented to the rehabilitation hospital after treatment for stroke. Magnetic resonance imaging showed multiple small acute infarcts in the bilateral ACA distribution, but no lesion in the corpus callosum. There were also prior infarcts in the right frontoparietal, left parietal, and left cerebellar regions, which had not affected upper-extremity function. Exam showed left hemiparesis (4/5). Right side was nonparetic (5/5) in the upper extremity. Left-hand grip was strong but the patient had impaired function on bimanual tasks. She was able to use the left hand given adequate stimulus (squeezing fingers), but had difficulty making spontaneous movements. She was unable to perform alternating movements. Assessment/Results: Intensive physical and occupational therapy improved function of the left hand. The patient developed markedly improved functional capacity with regard to bimanual activities of daily living such as dressing and eating. However, she remained unable to perform alternating movements with her hands, despite her functional gains. Discussion: This is callosal apraxia without a callosal lesion after embolic stroke involving numerous small ACA infarcts. As classically described, it affects only the left upper extremity despite involvement of both cerebral hemispheres. The lack of right upperextremity involvement precludes the diagnosis of sympathetic or left parietal apraxia. It presented a challenge in the rehabilitation of the patient, because integrated function between the 2 upper limbs was significantly impaired despite adequate strength and independent function of each side. Conclusions: Presence of a callosal apraxia may not be readily apparent when dealing with 1 or multiple ACA infarcts. This deficit requires more directed therapies to integrate the apractic left upper limb into functional activities despite the apparently mild impairments on that side.