Jang Sung Ho, Jang Woo Hyuk
From the Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Daegu, Republic of Korea.
Am J Phys Med Rehabil. 2016 Aug;95(8):e117-20. doi: 10.1097/PHM.0000000000000483.
We report on a patient who showed ideomotor apraxia due to injury of the superior longitudinal fasciculus following brain tumor and tumor bleeding, which was demonstrated by diffusion tensor tractography (DTT). A 60-yr-old, right-handed male patient underwent removal of brain meningioma and drainage of intraventricular hemorrhage and intracerebral hemorrhage in the left fronto-parietal lobe. At the time of DTT scanning (5 wk after onset), he was able to move the right upper extremity against gravity. The patient exhibited an intact ideational plan for motor performance. In addition, he was able to use actual objects (scissors, eraser) using his right wrist and hand. However, he had difficulty in using his right upper extremity for pantomime of object use, imitating gestures (meaningless or meaningful), and movement of his right upper extremity proximal. Score on the ideomotor apraxia test for the right side was 4 (cut-off score < 32). DTTs for the left superior longitudinal fasciculus to the left premotor cortex and left inferior parietal lobule showed partial injury, compared with the right superior longitudinal fasciculus. These injuries appeared to be the reason for ideomotor apraxia in this patient.
我们报告了一例因脑肿瘤及肿瘤出血导致上纵束损伤而出现观念运动性失用症的患者，这一情况通过弥散张量纤维束成像（DTT）得以证实。一名60岁的右利手男性患者接受了左额顶叶脑膜瘤切除及脑室内出血和脑内出血引流手术。在进行DTT扫描时（发病后5周），他能够对抗重力移动右上肢。患者在运动表现方面具有完整的观念性计划。此外，他能用右手腕和手使用实际物品（剪刀、橡皮擦）。然而，他在使用右上肢进行物品使用的模仿动作、模仿手势（无意义或有意义）以及右上肢近端运动时存在困难。右侧观念运动性失用症测试得分为4分（临界值<32分）。与右侧上纵束相比，从左侧上纵束到左侧运动前皮层和左侧顶下小叶的DTT显示存在部分损伤。这些损伤似乎是该患者出现观念运动性失用症的原因。
