Konagaya Masaaki, Sakai Motoko
Department of Neurology, Suzuka National Hospital, 3 2-1 Kasado, Suzuka-shi, Mie 513-8501, Japan.
Brain Nerve. 2007 May;59(5):533-6.
In this paper, we describe a case of mutiple sclerosis (MS) with diagonistic dyspraxia and the callosal lesions in MRI. The patient was a 54-year-old woman with 12 year-history of suffering from MS. Her clinical symptoms were left alien hand, mild euphoria, right blindness, left visual deficit (0.06), mild weakness of right upper limb, complete paraplegia of lower limbs, total sensory deficit below middle sternal level and neurogenic bladder. She was right-handed person and her alien hand was such a manner; when she intended to use spoon with right hand, her left hand aimlessly began to hold and release a cup or dish. Then, she was diagnosed as diagnostic dyspraxia. Neuropsychological examinations disclosed left hemispheric dysfunction including left hand agraphia and disconnection of the callosum. MRI showed patchy lesions in the callosum, right optic radiation, both side thalamus (left > right), left cerebral peduncle, and spinal cord of cervical to the thoracal portion. Although the functional disorders and the radiological atrophy of the callosum, the clinical manifestation of the callosal disconnection in MS cases has been scarcely reported, and this case seems to be a quite rare condition to be described.
在本文中,我们描述了一例患有多发性硬化症(MS)且伴有诊断性失用症及MRI显示胼胝体病变的病例。患者为一名54岁女性,有12年的MS病史。她的临床症状包括左手异己手现象、轻度欣快感、右眼失明、左眼视力缺损(0.06)、右上肢轻度无力、下肢完全性截瘫、胸骨中段以下完全感觉缺失以及神经源性膀胱。她是右利手,其异己手表现为:当她想用右手拿勺子时,左手会漫无目的地开始拿起并放下杯子或盘子。随后,她被诊断为诊断性失用症。神经心理学检查发现左半球功能障碍,包括左手失写症和胼胝体分离。MRI显示胼胝体、右侧视辐射、双侧丘脑(左侧>右侧)、左侧大脑脚以及颈段至胸段脊髓有斑片状病变。尽管胼胝体存在功能障碍和放射性萎缩,但MS病例中胼胝体分离的临床表现鲜有报道,该病例似乎是一种非常罕见的情况需要描述。