apraxia
Introduction
Introduction to apraxia Apraxia (apraxia) is the use of obstacles, refers to the dysfunction of the upper part of the brain after brain injury, manifested as the use of limbs in the absence of sputum and deep sensory disturbances, acquired acquired, random, purposeful Sexual, proficient use of behavioral disorders. The patient is conscious and can fully understand the actions required to complete, but can't perform it. He can't complete the purposeful skill movements that he had already mastered before the illness. This disability cannot be explained by primary sensory and motor impairments, nor by dementia, affective disorder, aphasia, loss of recognition, mental symptoms, and discommunication. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious complication:
Cause
Cause of apraxia
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.
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.
Prevention
Apraxia prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Apraxia complications Complication
If the limbs are not coordinated, the fine movements cannot be completed, so life cannot be taken care of.
Symptom
Symptoms of apraxia Common symptoms Bedridden dysarthria
1. The use of imagination cannot:
The correct meaning of the complex and delicate movements, the patient can correctly perform simple actions, but when doing fine and complex movements, the combination of time, order and action is wrong, resulting in the overall splitting and destruction of the action, and the order of actions is reversed. The actions to be performed later will be performed first. If the patient ignites the cigarette, put it in the mouth after burning the match. The lesions are more common in the posterior part of the left parietal lobe, the superior margin and the corpus callosum.
2. Sports use can not:
Only for the limbs, more common in the upper limbs. Due to the patient's memory impairment, the movement is clumsy, the fine motor ability is lacking, but the concept of movement remains intact. The heavy person can't do any action, and makes a number of movements that are meaningless to the examiner's request. For example, when sitting up in a lying position, the two lower limbs are lifted without the torso. The lesion site and the anterior to the right, or the motor cortex 4 and 6 regions, and the nerve fibers or the anterior part of the corpus callosum.
3. The use of conscious movement cannot:
In both cases, the patient can do simple and spontaneous movements, but can not complete complex random movements and imitative movements. The patient knows how to do it and can correctly describe it, but can not accurately complete the movement, and often has repeated movements. If you let it lift your foot, reach out. If the examiner requested to lift the left foot. Then, the left foot is lifted for any requirement in the future, and the damaged part is the fiber associated with the cortex of the parietal lobe and the cortex of the premotor area.
4. Structural use cannot:
The main manifestation is that the integration of multidimensional space cannot be achieved. Patients have certain understanding of the various components of structural activities such as painting, arrangement, and architecture, and their mutual understanding. However, the spatial analysis and comprehensive ability that constitutes a complete whole have obvious defects. For example, when a patient uses a match to swing a geometric figure, draw a house, or put a building block, the length and thickness are improper, improperly inclined, or other disproportionate, the rule disorder and the components are present, but the relative positions are excessively crowded, overlapping, Inverted, discrete, or completely neglected in spatial position, the entire pattern lacks a stereoscopic relationship. It is also often accompanied by half-side space neglect, the graph only draws the right half. Structural damage can occur in the parietal lobe lesion on either side, but it is evident when the right parietal lobe is damaged.
Examine
Apraxia check
On the basis of the medical history and comprehensive and focused examination, the focus should be on the patient's neurological signs, language function and cognitive function.
Selective and necessary auxiliary inspection items also include:
1. Blood routine, blood electrolytes, blood sugar, urea nitrogen, urine routine examination, have a differential diagnosis of the cause.
2. Cerebrospinal fluid examination also has a differential significance for the diagnosis of the cause.
Including ECG, ultrasound, CT and MRI examinations help to diagnose the location of the nervous system.
Diagnosis
Diagnosis of apraxia
diagnosis
Apraxia can only be diagnosed without obvious disturbance of consciousness or speech disorder (understandment disorder). The preconditions for diagnosis are: patients without any movement disorder, no paralysis, dystonia, involuntary movement or ataxia The patient is not a patient of all types of dementia.
1. The behavior of patients with conceptual apraxia seems to lack basic planning, which may be mistakenly diagnosed as ambiguity. When coexisting with sensory aphasia, it often misleads the diagnosis away from apraxia, which is the same as the use of innervation. The same is true, in rare cases, to the extent that clinical confirmation is achieved separately.
2. The concept of motor apraxia syndrome is most common in the limbs dominated by non-dominant hemispheres. At the same time, there are right hemiparesis and speech difficulties, often sporty, which often attracts the full attention of the clinician, so no abnormalities are found. The dominant hemisphere dominates the concept of motor apraxia in the limb.
With speech difficulties, it may not be possible to determine whether there is a conceptual motor apraxia. However, when the current person is light, it is usually found that the patient cannot make a commanding action, but they can imitate the behavior of the examiner and in other occasions. It can be performed spontaneously. When performing distal limb movements (such as fingers, hands) or oropharynx movements, the obstacles are most prominent, and the body axis and trunk movements are often not affected.
Lesions that cause apraxia are rarely localized, and even if they are not diffuse, they are often multiple, especially bilateral, especially in conceptual apraxia or complete apraxia.
Differential diagnosis
(a) cerebrovascular disease
The arteries that supply the superior and inferior parietal lobe are the posterior ganglia of the middle cerebral artery. Occlusion can cause disabling and other parietal damage, such as contralateral sensory disturbance, dyskinesia, and vestibular symptoms. Loss of relief and so on. There may be tactile retention, inversion, misrepresentation or positioning that cannot be performed. Clinically seen in infarction, cerebral arteritis, arteriovenous malformations.
(2) intracanal tumor (intracanial tumor)
Most of the parietal tumors are metastases, which are 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
Autism can occur when the cranial apical fracture causes acute parietal contusion, 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)
In addition to apraxia and other neurological manifestations, parietal abscesses often have primary infections. Pediatric patients may have a history of congenital heart disease with purpura, fever at the onset, increased white blood cells around the blood, and 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 a layer of translucent area. 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
The age-related Alzheimer's disease begins after the age of 65, and the condition is slowly aggravated. The clinical manifestation of dementia is the first clinical manifestation of the dementia, which is first forgotten, and it is forgotten. 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.
