Takada Kozue, Yamaguchi Takuya, Hyuga Yuko, Mitsuno Yuto, Horiguchi Satoshi, Kinoshita Masako, Satow Takeshi
Department of Neurology, National Hospital Organization Utano National Hospital, Kyoto, Japan.
Department of Rehabilitation, Nagahama City Hospital, Nagahama, Shiga, Japan.
Front Neurosci. 2023 Sep 28;17:1217430. doi: 10.3389/fnins.2023.1217430. eCollection 2023.
The mechanisms underlying bimanual coordination have not yet been fully elucidated. Here, we evaluated the clinical features of bimanual movement impairment in a patient following surgery for a frontal lobe tumor. The patient was an 80-year-old man who had undergone subtotal tumor resection for a tumor in the right superior frontal gyrus. Histological examination of the resected specimen led to the diagnosis of malignant lymphoma of the diffuse large B-cell type, and the patient subsequently received high-dose methotrexate-based chemotherapy. Postoperatively, the patient had difficulty with bimanual movement, and on the 5th postoperative day we found that the impairment could not be attributed to weakness. Temporal changes in the characteristics of manual movements were analyzed. Bimanual diadochokinesis (opening/closing of the hands, pronation/supination of the forearms, and sequential finger movements) was more disturbed than unilateral movements; in-phase movements were more severely impaired than anti-phase movements. Bimanual movement performance was better when cued using an auditory metronome. On the 15th postoperative day, movements improved. The present observations show that in addition to the disturbance of anti-phase bimanual movements, resection of the frontal lobe involving the supplementary motor area (SMA) and premotor cortex (PMC) can cause transient impairment of in-phase bimanual diadochokinesis, which can be more severe than the impairment of anti-phase movements. The effect of auditory cueing on bimanual skills may be useful in the diagnosis of anatomical localization of the superior frontal gyrus and functional localization of the SMA and PMC and in rehabilitation of patients with brain tumors, as in the case of degenerative movement disorders.
双手协调的潜在机制尚未完全阐明。在此，我们评估了一名额叶肿瘤手术后患者双手运动障碍的临床特征。该患者为一名80岁男性，因右侧额上回肿瘤接受了肿瘤次全切除术。对切除标本的组织学检查确诊为弥漫性大B细胞型恶性淋巴瘤，患者随后接受了以大剂量甲氨蝶呤为基础的化疗。术后，患者双手运动困难，在术后第5天我们发现这种障碍并非由无力所致。分析了手部运动特征的时间变化。双手轮替动作（双手的张开/闭合、前臂的旋前/旋后以及手指的顺序运动）比单侧运动受干扰更严重；同相运动比反相运动受损更严重。使用听觉节拍器提示时，双手运动表现更好。术后第15天，运动有所改善。目前的观察结果表明，除了反相双手运动受到干扰外，涉及辅助运动区（SMA）和运动前皮质（PMC）的额叶切除可导致同相双手轮替动作暂时受损，且这种受损可能比反相运动的受损更严重。听觉提示对双手技能的影响可能有助于诊断额上回的解剖定位以及SMA和PMC的功能定位，也有助于脑肿瘤患者的康复，就像在退行性运动障碍的情况下一样。
