Unable to use without motor or sensory impairment

Introduction Aphasia is the use of can not be, in the absence of exercise or sensory disturbances, in the case of purposeful or fine action, the performance of powerlessness, sometimes means that the body can not be used correctly with the cooperation of the whole body movement Habitual action. Apraxia occurs in the superior hemisphere under the lobular and marginal gyrus. Common diseases of apraxia are caused by cerebrovascular disease, intracranial tumor, intracranial inflammation and craniocerebral trauma. The painful cause of intentional use is mostly diffuse lesions of the brain.

Cause

Apraxia occurs in the superior hemisphere under the lobular and marginal gyrus. On the superior hemisphere, the commissural fibers are passed through the corpus callosum to reach the upper hemisphere of the lateral hemisphere. Therefore, the superior hemisphere upper cortex or subcortical lesions cause atrial disability in both limbs. When the lesion is enlarged to the central anterior gyrus, the dominant hemisphere dominates the lateral upper and lower extremities and the contralateral limb apraxia. The lesions in the corpus callosum are interrupted by the commissural fibers, which causes the superior lateral hemisphere to deviate from the dominant hemisphere, causing dominance side apraxia. Due to the interaction between the upper and lower sides of the two sides, unilateral apraxia is rare in the clinic.

an examination

Related inspection

Brain nerve examination

(1) Cerebrovascular disease: The artery supplying the superior and inferior parietal lobes is the posterior ganglia of the middle cerebral artery. The occlusion may cause apraxia and other parietal damage, such as the opposite side of the lesion. Sensory disturbances, dyskinesias, and vestibular symptoms, ataxia, etc. There may be tactile retention, inversion, misrepresentation or positioning that cannot be performed. Clinically seen in infarction, cerebral arteritis, arteriovenous malformations.

(B) intracranial tumor (intracanial tumor): the parietal tumor is mostly metastatic tumor, common in lung cancer metastasis. Direct compression or stretching of the local pain-sensitive site can cause localized localized headaches and local tenderness outside the skull. Increased intracranial pressure can cause headache, vomiting, optic nerve head edema and other manifestations. The focal symptoms are mainly sensory disturbances, which may have sensory ataxia, decreased muscle tone, muscle atrophy and tactile inattention, and may have systemic symptoms such as fever, anemia, and weight loss. A left-handed apraxia is caused when one third of the rest is involved, and there may be mental disorders, hemiparesis or quadriplegia. CT and MRI have certain value for the primary lesions of intracranial tumors.

(3) Trauma: Trauma of the parietal fracture caused by acute parietal fracture, often with conscious disturbance, sensory epilepsy or partial sensory disturbance. Patients with subacute and chronic subdural hematoma may have headache, lethargy, papilledema, and hemiparesis. Epidural hematoma consciousness disorder has intermediate awake period, severe headache, frequent vomiting, weak physical strength of the contralateral limb, obvious pyramidal tract sign, if necessary, X-ray film, cranial and ultrasound, CT and other confirmed diagnosis.

(4) intracranial infection (intracranial infection): parietal abscess in addition to misuse and other neurological manifestations, often have primary infections, pediatric patients may have a history of purpuric congenital heart disease, fever, around the onset There are leukocytosis in the blood and inflammatory cells in the cerebrospinal fluid. The CT examination may have a translucent area, a ring surrounded by contrast, and a translucent area outside. Herpes simplex encephalitis often has acute pain, and may have inflammatory symptoms, disturbance of consciousness, mental symptoms, convulsions, aphasia, hemiparesis, memory loss, increased cerebrospinal fluid pressure, cell number, and mild protein increase. A small number of patients can be isolated. Herpes virus, EEG has an abnormal wave consistent with the lesion site, and brain CT has a low-density area occupying effect. The diagnosis was based on brain biopsy, cerebrospinal fluid isolation of herpes simplex virus or antigen, and herpes simplex antibody was positive. More acute onset of sporadic encephalitis, about 60% have respiratory or digestive tract prodromal symptoms, often with mental disorders as the first symptom, with headache, vomiting, fever, limb paralysis, epilepsy and other symptoms, a few people have cranial nerve damage, More than 80% have EEG abnormalities, and the diagnosis should exclude viral encephalitis with clear pathogens. There is more controversy about the use of this disease name. Other Japanese encephalitis, toxoplasmosis, syphilis, cerebral malaria, cerebral schistosomiasis, and cerebral cysticercosis may all cause apraxia.

(5) Senile psychosis: Aged Alzheimer's disease begins after the age of 65, and the condition is slowly aggravated. The clinical manifestation of dementia is the first manifestation of recent oblivion, which is short-lived and forgotten. The victim is delusional. There are behavioral abnormalities, intellectual damage, emotional instability, irritability, etc., nervous system manifestations of aphasia, loss of use, agnostic syndrome and lip reflex, resistance to hypertonic hyperthyroidism, stereotactic action, epileptiform convulsions And myoclonic twitching, and gradually unable to take care of themselves, CT examination showed diffuse brain atrophy based on frontal and temporal lobe. The onset of old-age Alzheimer's disease before the age of 65, can be seen at the beginning of the onset of memory loss. Aphasia, loss of use, and loss of recognition, a rapid and particularly serious occurrence.

The intentional application can not be caused by bilateral lesions. The cause is mostly diffuse brain lesions. In addition to the above diseases, poisoning, Parkinson's syndrome, arteriosclerosis psychosis, paralytic dementia can be caused. Paralytic dementia is caused by treponema pallidum invading the brain parenchyma. It occurs 5 to 20 years after syphilis infection. It is more common in men, and the onset is late. There are neurasthenia syndrome or suspected disease in the early stage, and personality disorder and mental decline occur. The Ricky type is often caused by damage to the parietal lobe and temporal lobe. It is mainly characterized by hemiplegia, monoclinicity, hemianopia, aphasia, disuse and local convulsions. It gradually develops dementia and often dies in stroke. Other neurological symptoms may include Ayi Luo pupil, dysarthria, stuttering, speech vagueness and trembling, facial muscle tremors, hyperreflexia, Babinski sign positive.

The patient had a history of syphilis, increased cerebrospinal fluid lymphocytes and protein, 70% of the gold-gold curve was paralyzed, and both sides of the EEG diffuse high amplitude slow wave and serum syphilis positive. Arteriosclerotic psychosis starts from 50 to 60 years old. In the early stage, neurasthenia syndrome is the main symptom. The mental symptoms are characterized by memory loss and near forgotten, and fiction or misconfiguration occurs in the late stage. The patient's mood is unstable, irritating or violent crying, depression, anxiety, fear and anxiety, etc., the symptoms have certain volatility. Part of the self-knowledge remains even if there is a disease progression. In addition to apraxia, there are neurological symptoms such as head, hand, tongue tremor, increased muscle tone, asymmetry of tendon reflex, palmar reflex positive and autonomic dysfunction. CT examination showed signs of brain atrophy.

Differential diagnosis

1. The patient can automatically complete simple routine activities at the appropriate time, but cannot perform the same activities when requested by others. Patients with apraxia, although they have sufficient athletic ability, cannot perform specific activities automatically or on demand.

2. The patient cannot use the item correctly and cannot describe its function. Some IMAs use items that are clumsy, but can explain their purpose and purpose.

3. If a series of skilled exercises are required with an item, the apraly patient can describe the action and know what to do, but can't do it according to the instructions, or even try not at all. IA patients will try to do some simple and isolated parts of the series, but the items are not used correctly. There is no logic and planning in the process, and patients can not explain the procedures and purposes of the activities.

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