PHARMACOLOGICAL MANAGEMENT OF MOVEMENT DISORDER AFTER MIDBRAIN HEMORRHAGE

Movement disorders following midbrain haemorrhage are infrequently enc ountered in rehabilitation, and are uncommonly corrected by pharmacolo gic means. This report describes a 20 year-old male with a prior histo ry of cocaine abuse who presented with a 4 day history of dysarthria a nd blurred vision following methamphetamine abuse. Physical examinatio n demonstrated hypertension, left facial hemispasm, bilateral upward g aze paresis and ataxic gait. Magnetic resonance imaging/magnetic reson ance angiography (MRI/MRA) showed multifocal parenchymal haematomas in the mesencephalic tegmentum, subcortical left front region and right anterior thalamus consistent with cavernous angiomas. The patient was transferred to rehabilitation on hospital day 5. The following day, he developed choreoathetoid movements, dystonia, and aphasia, secondary to an extension of the midbrain haemorrhage. Cogentin was initiated wi th slight improvement in choreoathetoid movements. The patient began i ntensive multidisciplinary rehabilitation therapy but after 18 days of therapy, the patient remained totally dependent in activities of dail y living (ADLs), transfers, mobility and was unable to communicate in any manner. A trial of Sinemet was initiated, with resultant steady im provement in functional ability over the next month. By discharge, the patient was independent in ADLs and ambulation. By 9 months post disc harge follow-up, the patient was fully independent with normal cogniti on, and had self tapered all medications without ill effect. Dopamine agonist trials of appropriate duration appear indicated in cases of mo vement disorder (paucity or excess) following midbrain lesions.