Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, South Korea.
Med Sci Monit. 2022 Apr 18;28:e936417. doi: 10.12659/MSM.936417.
Limb-kinetic apraxia (LKA) is an execution disorder of movements caused by an injury to the secondary motor area (the supplementary motor area and premotor cortex) with preservation of an intact corticospinal tract (CST). A precise diagnosis of LKA is often limited because it is made based on the clinical observation of movement characteristics with confirmation of the CST state, and no specific clinical assessment tools for LKA have been developed. Diffusion tensor tractography (DTT) enables a three-dimensional estimation of the neural tracts related to LKA, such as the CST and corticofugal tract from the secondary motor area. This article reviewed 5 DTT-based studies on LKA-related neural tracts in stroke patients. These studies suggest that DTT could be a useful diagnostic tool for LKA along with previous diagnostic tools, such as brain magnetic resonance imaging and transcranial magnetic stimulation. In particular, DTT for the affected corticofugal tract can provide useful evidence for diagnosing LKA when clinicians cannot observe the movement characteristics because of severe weakness after a severe injury to the affected CST. Furthermore, a reviewed study suggested that LKA might be related to the unaffected neural tracts for motor function when the affected neural tracts were severely injured. This review summarizes the role of DTT in the diagnosis of LKA in stroke patients.
肢体运动性失用症（LKA）是一种由次级运动区（辅助运动区和运动前皮质）损伤引起的运动执行障碍，皮质脊髓束（CST）完好无损。由于肢体运动性失用症的诊断通常基于运动特征的临床观察，并确认 CST 状态，因此往往受到限制，而且尚未开发出针对肢体运动性失用症的特定临床评估工具。弥散张量成像（DTI）能够三维估计与肢体运动性失用症相关的神经束，例如来自次级运动区的 CST 和皮质传出束。本文综述了 5 项基于 DTI 的脑卒中患者肢体运动性失用症相关神经束的研究。这些研究表明，DTI 可能是一种有用的诊断工具，可以与之前的诊断工具（如脑磁共振成像和经颅磁刺激）一起用于肢体运动性失用症的诊断。特别是，当 CST 严重损伤导致运动无力严重时，针对受累皮质传出束的 DTI 可以为诊断肢体运动性失用症提供有用的证据。此外，一项综述研究表明，当受累神经束严重损伤时，肢体运动性失用症可能与运动功能未受累的神经束有关。本文综述总结了 DTI 在脑卒中患者肢体运动性失用症诊断中的作用。
