1421 - Ideational Apraxia Following a Left Middle Cerebral Artery Stroke: A Case Report

Case Diagnosis: Ideational apraxia

Case Description: A previously healthy 62-year-old right-hand dominant male presented to the emergency department with acute onset right arm weakness and altered speech. Workup with CT Angiogram of the head and neck revealed high-grade stenosis of the left cervical internal carotid artery, later confirmed on direct angiography. Serial CT head imaging and ultimately an MRI of the brain revealed a left frontoparietal lobe infarction consistent with a left MCA distribution stroke. Due to progression on serial imaging, he underwent a left carotid endarterectomy. Once stabilized, he discharged to inpatient rehabilitation. During initial activity of daily living (ADL) evaluation, he had inappropriate functional object use. For example, he attempted to brush his teeth with a hair comb. Overall, he scored 5 out of 12 on the Apraxia Screen of TULIA, consistent with severe apraxia, and this agnosia of utilization was most consistent with ideational apraxia.

Discussions: Ideational apraxia is a rare form of object use apraxia which can occur from left or right sided cerebral lesions. It is postulated that this apraxia is caused by a deficit in the ability to recall how to use an object from semantic memory and an inability to look at an object and determine relevant action from its structure. There are specific neurorestorative techniques utilized by treating therapists for this form of apraxia, including restorative gesture training and sequencing. In this case, the patient demonstrated ADL improvement with these methods during his rehabilitation stay.

Conclusions: Ideational apraxia is an uncommon form of apraxia with specific diagnostic criteria and treatment methods. We believe that it is important for physiatrists and treating therapists to recognize and appropriately diagnose this form of apraxia for appropriate management. We will review the neuroanatomy, pathophysiology, screening, and evidence based neurorestorative and compensatory treatment of ideational apraxia.