Report of a patient who showed diagonistic dyspraxia and marked dif ficulty in motor initiation of the left hand on verbal command

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  • 口頭命令に対する左上肢の運動の困難さが目立った拮抗性失行を呈した一症例

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A 61-year-old right-handed female developed motor aphasia the morning after undergoing coronary stenting for angina pectoris which was performed at a hospital. One month later she was admitted to our hospital for rehabilitation. She had undergone neurosurgical clipping of a ruptured IC-PC aneurysm 15years previously.<br>   On admission she was alert and her cranial nerves, motor, sensory and cerebellar functions were all normal. There was no grasping or groping reflexes in either hand. She was mute and uttered no words spontaneously, but was able to point at objects with her right hand. She also showed ideomotor apraxia, and marked difficulty in writing with her left hand, but not with her right hand. We judged the motor symptoms as a diagonistic apraxia (intermanual conflict) ; For instance, when asked to drink water from a cup that was placed on table with her right hand and then she tried to do so, her left hand grasped the cup and then involuntarily put it back where it was. In addition to the diagonistic apraxia she showed a motor initiation difficulty ; when asked to pick up the objects on the table with her left hand, she was unable to move her left hand to pick up the object. However, she could move her left hand involuntarily. CT revealed a cerebral infarction in the left frontal lobe and the corpus callosum from the genu to the splenium. IMP-SPECT (eZIS and vbSEE analysis) showed hypoperfusion in the bilateral lateral and medial frontal lobe. We thought that the diagonistic apraxia, the motor initiation difficulty and ideomotor apraxia in her left hand were induced by the both lesions in the corpus callosum and right medial frontal lobe.

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