Tei H, Soma Y, Uchiyama S, Maruyama S
Department of Neurology, Tokyo Women's Medical College.
Rinsho Shinkeigaku. 1993 May;33(5):556-8.
A case of diagnostic dyspraxia was reported. A 57-year-old right handed male had been suffering from the lack of cooperation between his right and left hands for six months. Except for decreased deep tendon reflexes in all extremities, there were no abnormal findings on neurological examination. On neuropsychological examination, he was attentive, well orientated and his spontaneous speech, comprehension, naming, repetition and reading were intact. There was peculiar dissociative behavior between his right and left hands. For instance, he put a cigarette or coin in the pocket with his right hand then his left hand took out and replaced them, and he buttoned his shirts with his right hand but then unbuttoned with his left hand. These left hand oppositional behavior to his right hand were triggered by voluntary activities of his right hand. Left unilateral agraphia was also revealed but ideomotor apraxia, compulsive manipulation of tools and grasp reflex were not demonstrated. T1-weighted MRI demonstrated irregular low signal intensity areas extending from the genu to the body of the corpus callosum. No definite lesion was detected in the medial aspect of the frontal lobe. Only small numbers of diagnostic dyspraxia have been reported and such cases without ideomotor apraxia or medial frontal lesion are even rare. MRI is very useful for detecting the lesion of the corpus callosum.
报告了一例诊断性失用症病例。一名57岁右利手男性，双手协作障碍已持续6个月。神经系统检查除四肢深腱反射减弱外，无其他异常发现。神经心理学检查显示，他注意力集中、定向力良好，自发语言、理解、命名、复述及阅读能力均正常。其左右手之间存在特殊的分离行为。例如，他用右手将香烟或硬币放入口袋，随后左手又将其取出并放回；他用右手扣衬衫扣子，接着左手又解开。这些左手对右手的对立行为由右手的自主活动触发。还发现了左侧单侧失写症，但未表现出观念运动性失用症、工具强迫性操作及抓握反射。T1加权磁共振成像（MRI）显示从胼胝体膝部延伸至体部的不规则低信号强度区域。额叶内侧未发现明确病变。仅报告过少数诊断性失用症病例，而无观念运动性失用症或额叶内侧病变的此类病例更为罕见。MRI对检测胼胝体病变非常有用。
