Isolated pure motor apraxia in the setting of depressed skull fracture: A case report and review of the literature

Abstract

Introduction: An isolated pure apraxia of speech following head trauma is a rare clinical presentation in the absence of any other neurologic deficit. It is more commonly seen in patients with vascular pathology. Confusion can exist in recognizing an apraxia of speech versus a true Broca’s aphasia. We report such a case in a patient undergoing significant head trauma. The pathology and its management are discussed. Case Report: A 41-year-old male presented to our Emergency Department with a 3 cm laceration to the left side of the head following an assault with an unknown object. The patient suffered a depressed skull fracture with underlying epidural hematoma, bilateral traumatic subarachnoid hemorrhages, and a resultant isolated pure motor apraxia of speech. He was treated effectively with an emergency frontoparietal craniotomy, elevation and repair of his skull fracture, and evacuation of his epidural hematoma. His pure motor apraxia was greatly improved post-operatively and the patient was referred to outpatient speech therapy with continued neurosurgical follow-up. Conclusion: This case represents the unusual presentation of a pure motor apraxia of speech following traumatic assault to the left frontoparietal skull. An excellent therapeutic response was obtained following surgical intervention and speech therapy.