Falchook Adam D, Burtis D Brandon, Acosta Lealani M, Salazar Liliana, Shushrutha Hedna Vishnumurthy, Khanna Anna Y, Heilman Kenneth M
a Department of Neurology , University of Florida , Gainesville , FL , USA.
Neurocase. 2014 Jun;20(3):317-27. doi: 10.1080/13554794.2013.770883. Epub 2013 Apr 5.
Studies of patients with brain lesions have demonstrated that language and praxis are mediated by dissociable networks. However, language has the capacity to influence the selection of purposeful actions. The abilities to use language and to program purposeful movements are often mediated by networks that have anatomic proximity. With hemispheric injury, the diagnosis of apraxia is often confounded by the specific influence of language impairments on the ability to select and produce transitive gestures. We report a patient who illustrates this confound. This patient is a right-handed man who developed global aphasia and neglect after a right hemispheric stroke. His right hand remained deft, and when asked to produce specific transitive gestures (pantomimes), he often performed normally but did make some body part as object and perseverative errors. However, he did not demonstrate the temporal or spatial errors typical of ideomotor apraxia. He also had a perseverative agraphia. Our patient's left hemisphere praxis system appeared to be intact, and the error types demonstrated during production of transitive gestures cannot be attributed to a degradation of postural and movement (praxis) programs mediated by his left hemisphere. The praxis errors types are most consistent with a deficit in the ability to select the necessary praxis programs. Thus, our patient appeared to have dissociation between language and praxis programs that resulted in body part as object and perseverative errors.
对脑损伤患者的研究表明，语言和运用能力由可分离的神经网络介导。然而，语言有能力影响有目的动作的选择。运用语言和规划有目的动作的能力通常由在解剖学上相邻的神经网络介导。在半球损伤时，失用症的诊断常常因语言障碍对选择和产生及物手势能力的特定影响而混淆。我们报告了一名体现这种混淆情况的患者。该患者是一名右利手男性，在右侧半球中风后出现完全性失语和偏侧忽视。他的右手依然灵活，当被要求做出特定的及物手势（模拟动作）时，他通常表现正常，但确实出现了一些将身体部位当作物体的错误和持续性错误。然而，他并未表现出观念运动性失用症典型的时间或空间错误。他还患有持续性失写症。我们患者的左半球运用系统似乎完好无损，在产生及物手势过程中表现出的错误类型不能归因于由其左半球介导的姿势和动作（运用）程序的退化。这些运用错误类型最符合选择必要运用程序能力的缺陷。因此，我们的患者似乎在语言和运用程序之间存在分离，导致了将身体部位当作物体的错误和持续性错误。
