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Final Program


Final Program

TBI

1002 - Clinical Pseudo-myotonia and Left-sided Neglect Following Penetrating Traumatic Brain Injury: A Case Report

Thursday, February 19, 2026
5:00 PM - 6:30 PM AST

    Presenting Author(s)

  • MH

    Megan N. Humphreys, n/a

    OMS IV
    Lincoln Memorial University - DeBusk College of Osteopathic Medicine
    Johnson City, Tennessee, United States

    • Co-Author(s)

  • DP

    Dillon J. Powell, MD

    Doctor of medicine
    University of Kentucky
    Lexington, Kentucky, United States

  • SP

    Stephen Porter, MD

    Attending Physician
    University of Kentucky Physical Medicine and Rehabilitation
    Lexington, Kentucky, United States

    • Submitter(s)

  • MH

    Megan N. Humphreys

    Lincoln Memorial University - DeBusk College of Osteopathic Medicine
    Johnson City, Tennessee, United States

Case Diagnosis: Clinically suspected pseudo-myotonia in the setting of penetrating traumatic brain injury with coexisting left-sided neglect and hemiparesis.

Case Description: A 59-year-old male with rheumatoid arthritis and alcohol use disorder sustained a gunshot wound to the chin. Imaging revealed right frontal intraparenchymal and intraventricular hemorrhages, subarachnoid hemorrhage, ballistic fragments in the right parieto-occipital region, and facial fractures. He underwent external ventricular drain placement and was admitted to inpatient rehabilitation after 13 days with left hemiparesis, neglect, and functional decline. On admission, neurological exam showed bilateral delayed grip release, more pronounced on the left and sometimes requiring manual assistance. The phenomenon was variable without pain, continuous contraction, or sensory loss. Given the temporal association with central injury, electrodiagnostic testing was deferred.

Occupational therapy targeted neglect and motor deficits with strengthening, mirror feedback, and task-specific training. Physical therapy emphasized gait, stair negotiation, and visual scanning. After 10 days, neglect improved from constant to intermittent cueing; however, delayed grip release persisted bilaterally in a waxing and waning pattern, worse on the left.

Discussions: Pseudo-myotonia describes delayed muscle relaxation without myotonic discharges, most often due to central lesions. This case is notable for bilateral presentation after unilateral penetrating TBI, suggesting involvement of bilateral motor control networks, potentially via interhemispheric pathways. Fluctuating severity may reflect influences of fatigue, attention, or task complexity, which are features less common in peripheral myotonia. Coexisting neglect compounded functional limitations by further slowing activities of daily living and requiring additional therapist cueing.

Conclusions: Bilateral pseudo-myotonia is a rare post-TBI finding that can persist despite rehabilitation and may amplify functional impairment. Early recognition in the rehabilitation setting can prevent unnecessary neuromuscular workups, guide targeted therapy (including task-specific release training and attentional cueing), and set realistic expectations for patients and caregivers.