Acosta L M, Bennett J A, Heilman K M
a Department of Neurology , University of Florida College of Medicine , Gainesville , FL , USA.
Neurocase. 2014;20(6):599-605. doi: 10.1080/13554794.2013.826683. Epub 2013 Aug 23.
According to Liepmann, patients with limb-kinetic apraxia (LKA) have a loss of upper limb deftness-dexterity. Prior studies have revealed in right-handed patients that, whereas injury of the left hemisphere induces an ipsilesional LKA, injury to the right hemisphere does not induce an ipsilesional LKA. There are at least two possible means by which the left hemisphere may influence the deftness of the left hand, either by callosal connections or by ipsilesional corticospinal projections. The purpose of this study was to learn whether a patient with a focal lesion of the corpus callosum had a callosal disconnection LKA. This 57-year-old right-handed man had a memory impairment, and upon brain imaging, was found to have a septum pellucidum cyst, which was causing mild ventricular obstruction to the occipital and temporal horns. He underwent an endoscopic-assisted fenestration of the septum pellucidum. Postoperative imaging revealed a lesion of the mesial portion of his corpus callosum and an assessment of praxis revealed that he had both a limb-kinetic and ideomotor apraxia of his left but not his right hand. The observation that this man had a callosal disconnection LKA of his left hand suggests that in some people it is the left hemisphere's premotor or motor cortex that enables the right hemisphere's motor system to program deft movements of the left hand.
根据利普曼的观点，肢体运动性失用症（LKA）患者上肢的灵巧性丧失。先前的研究表明，在右利手患者中，左半球损伤会导致同侧肢体运动性失用症，而右半球损伤则不会导致同侧肢体运动性失用症。左半球可能通过胼胝体连接或同侧皮质脊髓投射这两种方式来影响左手的灵巧性。本研究的目的是了解胼胝体局灶性病变患者是否存在胼胝体离断性肢体运动性失用症。这位57岁的右利手男性有记忆障碍，脑部成像发现他有透明隔囊肿，该囊肿对枕角和颞角造成轻度脑室梗阻。他接受了内镜辅助下透明隔开窗术。术后成像显示他的胼胝体中部有病变，对其运动能力的评估显示他左手存在肢体运动性和观念运动性失用症，而右手没有。该男子左手存在胼胝体离断性肢体运动性失用症这一观察结果表明，在某些人身上，是左半球的运动前区或运动皮层使右半球的运动系统能够规划左手的灵巧动作。
