Intermittent callosal apraxia due to the left dominat internal carotid artery stenosis: a case report *
A 69-year-old right-handed woman showed intermittent apraxia in the left upper and lower extremities following weakness of the right upper extremity and dysarthria. She was unable to use her left hand on verbal command and callosal apraxia was suspected. Physical examination disclosed left dominant bilataral carotid artery bruit. A diagnosis of callosal apraxia due to hypoperfusion in the left hemisphere was made. Brain MRI revealed multiple lacunar infarctions, but the corpus callosum was unremarkable. SPECT showed bilateral hypoperfusion, but especially of the left side. EEG disclosed diffuse slowing in the left hemisphere. MR A and DSA disclosed marked stenosis in the proximal side of left internal carotid artery. After a left carotid endarterectomy, SPECT and EEG findings normalized and the callosal apraxia improved. Callosal apraxia has been observed in various cases with callosal infarction, tumor, callosal AVM, trauma, Marchiafava-Bignami disease and demyelinating disease. Our case showed intermittent callosal apraxia without Gerstmann syndrome and agraphia. Callosal dysfunction or transient disconnection of the relay to corpus callosum was suspected. (Accepted on November 19, 1998) Kawasaki Igakkaishi 24 (4): 261-265, 1998
