What Are the Different Apraxia Symptoms?

Apraxia, also known as "uselessness" or "impossible use", occurs in the lower lobe and superior marginal injury of the superior hemisphere. The superior hemisphere marginal gyrus sends commissural fibers through the corpus callosum to reach and support the upper marginal gyrus of the lateral hemisphere. Therefore, lesions in the superior hemisphere cortex or subcortex cause apraxia of both limbs. When the lesion expanded to the central anterior gyrus, the dominant hemisphere dominated lateral paralysis of the upper and lower limbs and contralateral limb apraxia. A lesion is generated in the iliac crest, and due to the disruption of the commissural fibers, the contralateral superior gyrus is detached from the dominant hemisphere, causing dominating lateral apraxia. Due to the interaction between the upper margins of both sides, unilateral apraxia is rarely seen clinically.

Misuse

Apraxia is the inability to use. It is a state of inability to perform purposeful or fine movements when there is no movement or sensory disturbance. Sometimes it also means that a part of the limbs cannot be used correctly to cooperate with the whole body. Habitual action.

Pathogenesis of Apraxia

Apraxia, also known as "uselessness" or "impossible use", occurs in the lower lobe and superior marginal injury of the superior hemisphere. The superior hemisphere marginal gyrus sends commissural fibers through the corpus callosum to reach and support the upper marginal gyrus of the lateral hemisphere. Therefore, lesions in the superior hemisphere cortex or subcortex cause apraxia of both limbs. When the lesion expanded to the central anterior gyrus, the dominant hemisphere dominated lateral paralysis of the upper and lower limbs and contralateral limb apraxia. A lesion is generated in the iliac crest, and due to the disruption of the commissural fibers, the contralateral superior gyrus is detached from the dominant hemisphere, causing dominating lateral apraxia. Due to the interaction between the upper margins of both sides, unilateral apraxia is rarely seen clinically.

Common causes of apraxia are cerebrovascular disease, intracranial tumors, intracranial inflammation, and craniocerebral trauma. The pain factors that cannot be used intentionally are mostly diffuse brain lesions.

Clinical manifestations of apraxia

1. Intentional use can't be done: due to the lack of correct understanding of complex and delicate movements, patients can perform simple movements correctly, but when doing fine and complex movements, the combination of time, sequence and movements is wrong, resulting in the overall division and destruction of movements , The order of actions is reversed and disordered, and actions that should be executed later are performed in advance. If the patient is allowed to light a cigarette,

Misuse

Put it in your mouth. The lesions are more common in the posterior part of the left parietal lobe, superior marginal gyrus, and corpus callosum.

2. Sports use cannot: limited to the limbs, more common in the upper limbs. The patient's memory of the movement is impaired, resulting in awkward movements and lack of fine motor ability, but the concept of movement remains intact. The heavy person cannot do any movement, and make some meaningless movements to the inspector's requirements, such as lifting up both lower limbs without sitting on the trunk when sitting in a supine position. The site of injury and the superior marginal gyrus, or areas 4 and 6 of the motor cortex, and the nerve fibers or anterior corpus callosum from this area.

3. The use of conscious movement cannot: both the above two cases, the patient can do simple and spontaneous movements, but can not complete complex random movements and imitation movements, the patient knows how to do and can correctly describe, but can not complete the movements accurately , And often recurrence of movement. If he lifts his feet, he reaches out. If you have lifted your left foot as requested by the inspector. After that, the left foot is lifted for any requirements, and the damage site is the connecting fiber of the parietal locus and the pre-motor cortex.

4. Structural use cannot: mainly manifested in the inability to synthesize multi-dimensional space. Patients have a certain ability to understand the various components and their relationships of structural activities such as painting, arrangement, and architecture. There are obvious flaws. For example, when the patient is allowed to use a matchstick to place geometric figures, draw a house or put bricks, the length and thickness are improper, improper tilting is intermittent or other disproportionate. Although the phenomenon of regular disorder and various components exists, the relative position is too crowded, overlapping, Inverted, discrete or completely neglecting the spatial position, the whole pattern lacks a stereoscopic relationship. It is also often associated with half-sided space ignoring, and the figure only draws the right half. Damage to the parietal lobe on either side can cause structural apraxia, but it is apparent when the right parietal lobe is damaged.

Diagnosis of apraxia

(1) Cerebrovascular disease The arteries of the superior and inferior lobes of the superior marginal gyrus are posterior parietal branches issued by the middle cerebral artery. Occlusion can appear apraxia and other parietal lesions, such as the depth of the contralateral side Disorders, dyskinesias, and vestibular symptoms, ataxia, etc. There may be tactile stagnation, inversion, misidentification, or positioning failure. It is more common in infarction, cerebral arteritis and arteriovenous malformations.

(2) Intracranial tumors The tumors in the parietal lobe are mostly metastatic tumors, which are common in lung cancer metastases. The tumor directly compresses or pulls the local pain-sensitive area can cause localized localized headache with local tenderness outside the skull. Increased intracranial pressure can cause headache, vomiting, and optic papillary edema. Focal symptoms are mainly sensory disorders, which may have sensory ataxia, weakened muscle tone, muscle atrophy, and tactile inattention, and may have systemic symptoms of tumors such as fever, anemia, and weight loss. Left-hand-related apraxia is caused when 1/3 of the rest is affected, which may be accompanied by mental disorders, hemiplegia or quadriplegia. CT and MRI are of certain value for the primary lesions of intracranial tumors.

(3) Trauma: Apraxia may occur when an acute parietal contusion is caused by a fracture of the cranial parietal head, often with conscious disturbance, sensory epilepsy, or anaesthetic. Patients with subacute and chronic subdural hematomas may have headaches, drowsiness, papillary edema, and hemiplegia. The epidural hematoma is often conscious in the midwaking period, with severe headache, frequent vomiting, weak contralateral limbs, and obvious cone tract signs. X-ray film, cranial and ultrasound, and CT can be used to confirm the diagnosis if necessary.

(IV) Intracranial infection In addition to apraxia and other neurological manifestations, parietal abscesses often have primary infections. Pediatric patients may have a history of cyanotic congenital heart disease, fever, and peripheral blood at the time of onset. Leukocytosis, inflammatory cells in the cerebrospinal fluid, CT examination of the lesion site may have a translucent area, surrounded by a ring with a strong contrast, and then outside is a layer of translucent area. Herpes simplex encephalitis often has acute pain, and may have inflammatory symptoms, disturbances of consciousness, mental symptoms, convulsions, aphasia, hemiplegia, memory decline, increased cerebrospinal fluid pressure, slightly increased cell count, and protein, and a few patients can be isolated. Herpes virus, EEG has abnormal waves consistent with the lesion, and CT of the brain 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 antibodies were positive. Sporadic encephalitis usually has acute onset. About 60% have prodrome symptoms of breathing or digestive tract. Mental disorder is the first symptom, with headache, vomiting, fever, limb paralysis, epilepsy, etc. A few people have damaged cranial nerves. More than 80% have abnormal EEG, diagnosis should be ruled out viral encephalitis with clear pathogens. There is more controversy over the use of this disease name. Other types of encephalitis, toxoplasmosis, syphilis, cerebral malaria, cerebral schistosomiasis, and cerebral cysticercosis can all cause apraxia.

(5) Senile psychosis. Senile Alzheimer's disease begins after the age of 65, and the disease slowly worsens. Dementia is the main clinical manifestation. Forgetting recent events, forgetting the details, and forgetting the current events, can cause harm. Delusion. With abnormal behavior, intellectual impairment, emotional instability, irritability, etc., the nervous system manifests aphasia-apraxia-failure syndrome and lip reflex, resistance hypertonicity, stereotyped movements, and epilepsy-like convulsions can also occur. And myoclonic twitching, and gradually unable to take care of themselves, CT examination showed diffuse brain atrophy, mainly in the frontal and temporal lobes. The onset of old-stage Alzheimer's disease occurs before the age of 65, and it can be seen at the beginning of the onset of amnesia. Aphasia, apraxia, and aphasia are rapidly and particularly severe.

Intentional use cannot generally be caused by bilateral lesions. The cause is mostly diffuse brain lesions. In addition to the above diseases, poisoning, Parkinson's syndrome, arteriosclerotic psychosis, and paralytic dementia can be caused. Paralytic dementia is caused by Treponema pallidum invasion of the brain parenchyma. It usually occurs 5 to 20 years after syphilis infection. It is more common in men and has latent onset. It has early signs of neurasthenia or suspected disease, and then appears personality disorders and mental retardation. Among them, Riemann's type is often caused by damage to the parietal and temporal lobe. Hemiplegia, monoparesis, hemiplegia, aphasia, apraxia, and local convulsions are the main manifestations. Dementia gradually develops, and often die of stroke. Other neurological symptoms may include Al-Iro's pupils, dysarthria, stuttering, vague speech and tremors, lingual and facial muscle tremors, hypertenoid reflexes, and positive Babinski sign. The patient had a history of syphilis, increased cerebrospinal fluid lymphocytes and protein, 70% gel-gold curve was paralyzed, diffuse high wave amplitude slow waves on both sides of the EEG, and positive serum syphilis. Arteriosclerotic psychosis begins at the age of 50 to 60 years. It is mainly a neurasthenia syndrome in the early stage, and its mental symptoms are characterized by memory loss and recent forgetfulness, and fiction or misconstruction occurs in the later stage. The patient's mood is unstable, irritability increases or fulminant crying, suspicious depression, fear and anxiety are present, and the symptoms have certain fluctuations. Part of self-awareness persists even during disease progression. In addition to apraxia, there are neurological symptoms such as head, hand, and tongue tremors, increased muscle tone, asymmetric tendon reflexes, positive palmoplantar reflexes, and autonomic dysfunction. CT examination showed signs of brain atrophy.