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Delayed Onset Eye Opening Apraxia due to Progression of Brain Atrophy following Subthalamic Nucleus Deep Brain Stimulation: A Case Report

Eye opening apraxia (EOA) has been described in literature as a complication of deep brain stimulation (DBS), especially after electrode implantation in the subthalamic nucleus (STN). EOA can be either worsened or alleviated by DBS depending on the etiology. Herein, we report a rare case where the p...

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Autores principales: Morishita, Takashi, Higuchi, Masa-aki, Tsuboi, Yoshio, Samura, Kazuhiro, Inoue, Tooru
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japan Neurosurgical Society 201
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364898/
https://www.ncbi.nlm.nih.gov/pubmed/28664016
http://dx.doi.org/10.2176/nmccrj.cr.2016-0012
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author Morishita, Takashi
Higuchi, Masa-aki
Tsuboi, Yoshio
Samura, Kazuhiro
Inoue, Tooru
author_facet Morishita, Takashi
Higuchi, Masa-aki
Tsuboi, Yoshio
Samura, Kazuhiro
Inoue, Tooru
author_sort Morishita, Takashi
collection PubMed
description Eye opening apraxia (EOA) has been described in literature as a complication of deep brain stimulation (DBS), especially after electrode implantation in the subthalamic nucleus (STN). EOA can be either worsened or alleviated by DBS depending on the etiology. Herein, we report a rare case where the progression of brain atrophy may have contributed to the delayed onset of EOA. The patient, a 73-year-old woman, had previously undergone bilateral STN-DBS for advanced Parkinson’s disease (PD), which was performed by another DBS team, at the age of 68 years. She initially experienced a dramatic improvement in her motor symptoms, with no adverse events. However, she had difficulty in opening her right eye 3 years after the DBS surgery. Imaging studies showed that the brain atrophy had progressed over the past 5 years, and that the DBS electrodes were implanted through the far anterior entry points. We considered that the relative movement of the DBS might have been caused by the progression of the brain atrophy to the posterior limb of the internal capsule (IC) where the corticobulbar tract exists, and this was enhanced by the lower implantation angle. The present case illustrates the importance of the DBS insertion angle considering the a+ trophic effect and the follow-up imaging studies after DBS.
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spelling pubmed-53648982017-06-29 Delayed Onset Eye Opening Apraxia due to Progression of Brain Atrophy following Subthalamic Nucleus Deep Brain Stimulation: A Case Report Morishita, Takashi Higuchi, Masa-aki Tsuboi, Yoshio Samura, Kazuhiro Inoue, Tooru NMC Case Rep J Case Report Eye opening apraxia (EOA) has been described in literature as a complication of deep brain stimulation (DBS), especially after electrode implantation in the subthalamic nucleus (STN). EOA can be either worsened or alleviated by DBS depending on the etiology. Herein, we report a rare case where the progression of brain atrophy may have contributed to the delayed onset of EOA. The patient, a 73-year-old woman, had previously undergone bilateral STN-DBS for advanced Parkinson’s disease (PD), which was performed by another DBS team, at the age of 68 years. She initially experienced a dramatic improvement in her motor symptoms, with no adverse events. However, she had difficulty in opening her right eye 3 years after the DBS surgery. Imaging studies showed that the brain atrophy had progressed over the past 5 years, and that the DBS electrodes were implanted through the far anterior entry points. We considered that the relative movement of the DBS might have been caused by the progression of the brain atrophy to the posterior limb of the internal capsule (IC) where the corticobulbar tract exists, and this was enhanced by the lower implantation angle. The present case illustrates the importance of the DBS insertion angle considering the a+ trophic effect and the follow-up imaging studies after DBS. The Japan Neurosurgical Society 2016 -11- 29 /pmc/articles/PMC5364898/ /pubmed/28664016 http://dx.doi.org/10.2176/nmccrj.cr.2016-0012 Text en Copyright © 2017 The Japan Neurosurgical Society This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Case Report
Morishita, Takashi
Higuchi, Masa-aki
Tsuboi, Yoshio
Samura, Kazuhiro
Inoue, Tooru
Delayed Onset Eye Opening Apraxia due to Progression of Brain Atrophy following Subthalamic Nucleus Deep Brain Stimulation: A Case Report
title Delayed Onset Eye Opening Apraxia due to Progression of Brain Atrophy following Subthalamic Nucleus Deep Brain Stimulation: A Case Report
title_full Delayed Onset Eye Opening Apraxia due to Progression of Brain Atrophy following Subthalamic Nucleus Deep Brain Stimulation: A Case Report
title_fullStr Delayed Onset Eye Opening Apraxia due to Progression of Brain Atrophy following Subthalamic Nucleus Deep Brain Stimulation: A Case Report
title_full_unstemmed Delayed Onset Eye Opening Apraxia due to Progression of Brain Atrophy following Subthalamic Nucleus Deep Brain Stimulation: A Case Report
title_short Delayed Onset Eye Opening Apraxia due to Progression of Brain Atrophy following Subthalamic Nucleus Deep Brain Stimulation: A Case Report
title_sort delayed onset eye opening apraxia due to progression of brain atrophy following subthalamic nucleus deep brain stimulation: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364898/
https://www.ncbi.nlm.nih.gov/pubmed/28664016
http://dx.doi.org/10.2176/nmccrj.cr.2016-0012
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