405 - Supplemental Motor Area Syndrome After Arteriovenous Malformation Resection: A Case Report

Case Diagnosis: 48 year old Female with Supplementary Motor Area Syndrome after resection of arteriovenous malformation.



Case Description: Patient with a past medical history of HTN presented to neurosurgery clinic with a newly diagnosed arteriovenous malformation after having seizures. MRI brain revealed a right paramedian arteriovenous malformation. Patient underwent AVM embolization and was found to have left sided hemiplegia post op. Patient returned to the operating room the following day for right craniotomy for AVM resection. Patient also found to have moderate cognitive-communicative impairment and mild receptive/expressive aphasia. Her constellation of symptoms and anatomical location of AVM embolization is consistent with Supplemental Motor Area Syndrome. Patient was transferred to inpatient rehab for further management. Patient progressed with therapies, and on discharge was able to ambulate 255 feet with minimum assistance.



Discussions:
Supplementary Motor Area (SMA) Syndrome is a neurological disorder characterized by dysfunction in the supplementary motor area of the brain, leading to impaired motor planning and execution on the contralateral side of the body. Damage to the SMA disrupts the brain's ability to initiate complex and coordinated movements, often resulting in apraxia and difficulties in performing purposeful actions.



SMA syndrome is a frequently encountered clinical phenomenon associated with surgery of the dorsomedial prefrontal lobe. The region has a known motor sequencing function, and the dominant pre-SMA region is associated with more complex language functions. SMA syndrome is associated with problems involving speech fluency and articulation. SMA syndrome has a good functional prognosis and most patients have a partial or even complete recovery after 2-3 months.

Conclusions:
Surgically induced Supplementary Motor Area Syndrome may result from arteriovenous malformation resection. SMA Syndrome is characterized by motor weakness and speech dysfunction. SMA syndrome is known to have a good functional prognosis with complete recovery possible.