Appearance of asymmetric tonic neck reflex in a patient with astrocytoma which was surgically removed and CVA wih Bilateral Pyramidic Syndrome – Case Report

Aim: The presentation of a patient with a primitive long reflex that prevents the training of the motor control in a patient following a typical neurosurgical removal of astrocytoma.

Material – Method: A 34-year-old man underwent craniotomy for an astrocytoma exclusion (grade 1) in the right frontal lobe, and he exhibited a left pyramidal syndrome. The next day he suffered post-operative ischemic stroke, on the left, clinically showing bilateral pyramidal involvement, with permanent head turning to the left. This triggered the release of the asymmetric long tonic reflex of the neck, with its characteristic posture (swordsman), that is, contrary to head shifting extension pattern of the hand and flexion pattern at the lower limb, and along with the head rotation, flexion pattern at the upper limb and extension in the lower limb. It shows great spasticity (Modified Ashworth scale 4/4).

Results: Patient maintains a good level of perception. For spasticity management and facilitation of motor control reeducation, botulinum toxin (300 u.i.) was injected into the muscles controlling the rotational movements of the head as long as they were responsible for creating this particular tonic neck reflex pattern. It was followed by a hydrotherapy program, kinesiοtherapy in water environment, and special training program for head movements, sitting and balance.

Conclusions: The importance of head position in patients with severe brain damage and bilateral pyramidal assistance is great, because it can trigger poly-synaptic reflexes that prevent the rehabilitation programming, which main target first is the correction of hand position.