Affiliations: [a] Department of Physical Therapy, Sun Moon University, Asan-Si, Republic of Korea | [b] Department of Neurology, College of Medicine, Yeungnam University, Taegu, Republic of Korea | [c] Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, Republic of Korea | [d] Department of Diagnostic Radiology, College of Medicine, Yeungnam University, Taegu, Republic of Korea
Correspondence:
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Corresponding author: Sung Ho Jang, MD, Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University 317-1, Daemyungdong, Namku, Taegu, 705-717, Republic of Korea. Tel.: +82 053 620 3269; Fax: +82 53 620 3269; E-mail: [email protected], [email protected]
Abstract: 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.
Keywords: Diffusion tensor imaging, ideomotor apraxia, limb-kinetic apraxia, superior longitudinal fasciculus, premotor cortex, supplementary motor area
