Síndrome de área motora suplementaria postoperatoria: Reporte de un caso / Postoperative supplementary motor area syndrome: Report of one case

ABSTRACT

Objective: To analyze the anatomical and semiological features of the syndrome of the SMA through the presentation of a patient. Description 55 female. Two yrs history of generalized convultions. Left frontomedial lesion biopsied outwards. PA low grade astrocytoma. Medically trated until feb 2007. Sudden headache and right sided hemiparesis with crural predominance. Hoffmann and slight right hyper reflexia. MRI expansion of primary lesion with intra lesional hemorrhage. Surgical resection. PA mixed anaplastic glioma. The inmediate postoperative status was of a right CB plejia with severe apathy and abulia with right spatial hemineglect and hypofluent and anomic language, with preserved repetition and comprehension. Total recovery of paresis and language except when stressed. Discussion: The SMA is limited by cingulated cortex inferiorly, PMC posteriorly, and vertex surperiorly. The anterior border is not well defined. SMA activates before the PMC, during planification and iniciation of movement. Is connected with the PMC, spinal cord neurons, basal ganglia and contralateral SMA. By intraoperative stimulation it could be established the somatotopic organization of SMA, with the hindlimb posterior the forelimb intermediate and face anterior. Before the facial representation is the language area in the dominant hemisphere. Epileptogenic crisis originated in this area produce abduction and supination of the contralateral forelimb with deviation of the head to the same side. The syndrome of lesion of SMA includes global akinesis, proximal predominance of motor deficit, with secuelar difficulty for the fine movements of hands an a quick recuperation (days to weeks). Conclusion: The syndrome of the supplementary motor area is well recognized after medial frontal lobe surgery. Its features include reduction of spontaneous movements in the contralateral limbs and speech deficit. The impairment of volitional movements is the main finding...