Limb apraxia in a patient with cerebral infarct: diffusion tensor tractography study.
We report on a patient with ideomotor apraxia (IMA) and limb-kinetic apraxia (LKA) following cerebral infarct, which demonstrated neural tract injuries by diffusion tensor tractography (DTT). A 67-year-old male was diagnosed as cerebral infarct in the left frontal cortex (anterior portion of the precentral gyrus and prefrontal cortex) and centrum semiovale. The patient presented with severe paralysis of the right upper extremity and mild weakness of the right lower extremity at onset. At the time of DTT scanning (5 months after onset), the patient was able to move all joint muscles of the right upper extremity against gravity, except for the finger extensors, which he could extend partially against gravity. The patient showed intact ideational plan for motor performance; however, his movements were slow, clumsy, and mutilated when executing grasp-release movements of his affected hand. The patient's score on the ideomotor apraxia test was 20 (cut-off score < 32). DTTs for premotor cortex fibers, supplementary motor area fibers, and superior longitudinal fasciculus of the left hemisphere showed partial injuries, compared with those of the right side, and these injuries appeared to be responsible for IMA and LKA in this patient.
Department of Physical Therapy, Sun Moon University, Asan-Si, Republic of Korea.
Ji Heon
JH
Hong
Jun
J
Lee
Yoon Woo
YW
Cho
Woo Mok
WM
Byun
Hee Kyung
HK
Cho
Su Min
SM
Son
Sung Ho
SH
Jang
D000368:Aged; D001259:Ataxia / Q000150:complications* / Q000175:diagnosis*; D001921:Brain / Q000473:pathology; D002544:Cerebral Infarction / Q000150:complications*; D038524:Diffusion Magnetic Resonance Imaging; D007839:Functional Laterality; D006801:Humans; D008297:Male