一名患有后皮质萎缩和可能的皮质鼻综合征的患者的选择性手部姿势失调症。

IF 1.3 4区 医学 Q4 BEHAVIORAL SCIENCES Cognitive and Behavioral Neurology Pub Date : 2023-06-01 DOI:10.1097/WNN.0000000000000339
Tomohiro Omori, Michitaka Funayama, Sachiko Anamizu, Mei Ishikawa, Richi Niida, Hajime Tabuchi
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引用次数: 0

摘要

在获得性脑损伤患者中,很少有报道称需要使用特定工具才能做出手势的选择性损伤,而在退行性疾病患者中,这种损伤也根本没有记录。我们描述了一名患有后皮质萎缩和可能的皮质基底综合征的患者,他由于无法做出每种工具所需的正确手部姿势而无法使用工具。然而,一旦她的手部姿势得到纠正,并且她操纵工具的能力(即时间、手臂姿势和幅度)完好无损,这个人就能够正确使用工具。此外,她在测试自己的操纵知识方面也没有遇到任何困难。单光子发射计算机断层扫描观察到的低灌注区域包括左顶叶的顶内前沟,这是一个被认为可以控制手部姿势的区域。这种选择性损伤可以用基于推理的失用症假说来解释,该假说将在没有操作错误的情况下的手姿势错误归因于辅助工具使用的三个独立途径之一的功能障碍,而不是基于操作的失用者假说,其将手姿势错误归咎于操作知识受损。这是第一例退行性疾病,显示出对使用工具的手部姿势的选择性损伤,这可能主要是由于手部姿势失用症以及视觉空间功能障碍(同时认知)和/或感觉障碍。
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A Selective Hand Posture Apraxia in an Individual With Posterior Cortical Atrophy and Probable Corticobasal Syndrome.

A selective impairment for making hand postures that are required to use specific tools has rarely been reported in individuals with acquired brain injury, and such an impairment has not been documented at all in individuals with degenerative disorders. We describe an individual with posterior cortical atrophy and probable corticobasal syndrome who was unable to use tools because of an inability to make the proper hand posture required for each tool. This individual was, however, able to use the tools properly once her hand postures were corrected, and her ability to manipulate the tools (ie, timing, arm posture, and amplitude) was intact. Also, she had no difficulty with a test of her manipulation knowledge. Areas of hypoperfusion observed by single-photon emission computerized tomography included the anterior intraparietal sulcus in the left parietal lobe, which is an area that has been proposed to control hand postures. This selective impairment might be explained by the reasoning-based hypothesis for apraxia, which attributes hand posture errors in the absence of manipulation errors to dysfunction in one of the three independent pathways that subserve tool use, rather than the manipulation-based hypothesis for apraxia, which attributes hand posture errors to impaired manipulation knowledge. This is the first case with a degenerative disorder that revealed a selective impairment for making hand postures for tool use, which might be explained mainly by apraxia of hand postures along with visuospatial dysfunction (simultanagnosia) and/or sensory disturbance.

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来源期刊
CiteScore
2.40
自引率
7.10%
发文量
68
审稿时长
>12 weeks
期刊介绍: Cognitive and Behavioral Neurology (CBN) is a forum for advances in the neurologic understanding and possible treatment of human disorders that affect thinking, learning, memory, communication, and behavior. As an incubator for innovations in these fields, CBN helps transform theory into practice. The journal serves clinical research, patient care, education, and professional advancement. The journal welcomes contributions from neurology, cognitive neuroscience, neuropsychology, neuropsychiatry, and other relevant fields. The editors particularly encourage review articles (including reviews of clinical practice), experimental and observational case reports, instructional articles for interested students and professionals in other fields, and innovative articles that do not fit neatly into any category. Also welcome are therapeutic trials and other experimental and observational studies, brief reports, first-person accounts of neurologic experiences, position papers, hypotheses, opinion papers, commentaries, historical perspectives, and book reviews.
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