Hanna-Pladdy B, Heilman K M, Foundas A L
Department of Neurology, University of Florida, Gainesville 32610-0236, USA.
Brain. 2001 Dec;124(Pt 12):2513-27. doi: 10.1093/brain/124.12.2513.
Ideomotor apraxia (IMA) is often associated with damage of the dominant parietal cortex, but many other lesion sites have been implicated suggesting that the praxis system is mediated by a distributed modular network. Although IMA has been reported with subcortical lesions, the role of subcortical structures in the praxis neural network has not been fully addressed. To ascertain the role of subcortical structures in praxis, we compared praxis performance on a variety of tasks in patients with left hemisphere cortical and subcortical lesions. The cortical patients presented with deficits in the production of transitive and intransitive gestures-to-verbal command and imitation, as well as impaired gesture discrimination. In contrast, the subcortical group demonstrated mild production-execution deficits for transitive pantomimes, but normal imitation and discrimination. Qualitative error analysis of production deficits, revealed that both patient groups produced timing errors and the full range of spatial errors. Whereas the subcortical group made more postural errors than the cortical group, sequencing, unrecognizable and no-response errors were only produced by the cortical group. The different profiles of praxis deficits associated with cortical and subcortical lesions, suggests that these structures may have different roles in praxis.
观念运动性失用症（IMA）常与优势顶叶皮质损伤相关，但许多其他病变部位也被认为与此有关，这表明运动实践系统是由一个分布式模块化网络介导的。尽管已有报道IMA与皮质下病变有关，但皮质下结构在运动实践神经网络中的作用尚未得到充分探讨。为了确定皮质下结构在运动实践中的作用，我们比较了左半球皮质和皮质下病变患者在各种任务中的运动实践表现。皮质病变患者在对言语指令和模仿的及物和不及物手势产生方面存在缺陷，并且手势辨别能力受损。相比之下，皮质下病变组在及物手势模仿方面表现出轻微的产生-执行缺陷，但模仿和辨别能力正常。对产生缺陷的定性错误分析表明，两组患者都出现了时间错误和各种空间错误。虽然皮质下病变组比皮质病变组出现更多的姿势错误，但序列错误、无法识别和无反应错误仅出现在皮质病变组。与皮质和皮质下病变相关的运动实践缺陷的不同特征表明，这些结构在运动实践中可能具有不同的作用。
