右運動前野の脳挫傷後に四肢失行や失語を伴わずに口腔顔面失行を発症した1症例

Buccofacial Apraxia without Limb Apraxia or Aphasia after Right Premotor Area Contusion: A Case Report

Ⅰ．はじめに

　頭部外傷後に意識が改善し，四肢の明らかな麻痺や失行を認めないにもかかわらず，口腔および顔面の随意運動のみが両側性に障害されることは比較的稀である．このような障害は口腔顔面失行と呼ばれ，右利きの人では，左半球の障害で引き起こされるとされている．今回われわれは，右利きにもかかわらず，右前頭葉弁蓋部と右運動前野の脳挫傷により，失語を伴わずに口腔顔面失行を来した1症例を経験したので報告する．

　Facial apraxia, as well as aphasia, has been associated with lesions in the cerebral hemisphere contralateral to the dominant hand. We describe a patient with severe facial apraxia caused by contusion in the right frontal operculum, premotor area and primary motor cortex ipsilateral to the dominant hand. The patient had no aphasia or limb apraxia. Magnetic resonance images of the brain reveal no abnormality of the hemisphere contralateral to the dominant hand. Thus, in some individuals, facial praxis is controlled by the hemisphere non-dominant for both handedness and language.