Case Diagnosis: Anoxic brain injury with motoric, cognitive, and communicative deficits.
Case Description or Program Description: A 39-year-old male with a history of diabetes sustained an alcohol-related anoxic brain injury 11 years prior. This is his first follow-up in 5 years. At the last follow-up, he had been receiving monthly transcranial magnetic stimulation which reportedly assisted in regulating his mood and improving his cognitive function and memory. Sessions were no longer funded and he attempted to find alternative adjuvant therapies. Self-prescribed inhaled marijuana was trialed which reportedly improved cognition, memory, and function.
Setting: Outpatient clinic.
Assessment/Results: On physical exam, the patient had perseverative, aprosodic, pressured speech, functional falsetto, poor semantics, and visible anxiety. He ambulated with rapid, small, heel-toe gait. When observed in a recording, after smoking marijuana the patient’s speech was no longer pressured, appropriate pauses were employed, cadence normalized, and tone of speech prevailed. Position and mobility of his extremities improved as well.
Discussion (relevance): Medicinal marijuana has been touted as an alternative treatment for a myriad of diseases. High affinity of cannabidiol for CB1 and CB2 receptors alters neurotransmission by reducing presynaptic neurotransmitter release at excitatory and inhibitory synapses. This reduces lesion volume and restores vestibulomotor and cognitive function. Tetrahydrocannabinol increases the quantity of CB1 receptors in the basal ganglia, complementing CBD effects in movement disorders and, in some clinical trials, restoring locomotor activities to pre-disease levels. Additionally, marijuana causes a release of dopamine, which in this patient may be at least responsible for the clinical improvements noted.
Conclusions: Medical marijuana may have a role in treating assorted movement disorders. While little is understood about the mechanism of action of marijuana, little is also known about this patient’s movement disorder. He has demonstrable improvement in function, inclination, and initiation. This case raises questions about the treatment of movement disorders, combined options, and the mechanism and uses of marijuana.
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