Fast micrographia: An unusual but distinctive sign

Area of Science:

• Neurology
• Neuroimaging
• Pathology

Background:

• Fast micrographia is a rare clinical sign associated with pallidal pathology.
• Hypoxic ischemic encephalopathy can result from severe systemic events like myocardial infarction with hemodynamic distress.

Purpose of the Study:

• To report a case of fast micrographia in a patient with hypoxic ischemic encephalopathy.
• To correlate clinical findings with neuroimaging in a patient with pallidal pathology.

Main Methods:

• Clinical presentation of a 68-year-old male with hypophonia and shuffling gait.
• Neurological examination including assessment of handwriting and rapid alternating movements.
• Brain Magnetic Resonance Imaging (MRI) to evaluate for hypoxic ischemic encephalopathy.

Main Results:

• The patient exhibited fast micrographia and hypophonia after a myocardial infarction and respiratory distress.
• Brain MRI revealed bilateral hyperintensities in the globus pallidus and putamen, indicative of hypoxic ischemic encephalopathy.
• Normal rapid alternating hand and finger movements were noted.

Conclusions:

• Fast micrographia can be a presenting sign of pallidal injury secondary to hypoxic ischemic encephalopathy.
• Neuroimaging findings support the association between pallidal pathology and fast micrographia in this clinical context.