Ideomotor Apraxia Due to Injury of the Superior Longitudinal Fasciculus

We report on a patient who showed ideomotor apraxia due to injury of the superior longitudinal fasciculus following brain tumor and tumor bleeding, which was demonstrated by diffusion tensor tractography (DTT). A 60-yr-old, right-handed male patient underwent removal of brain meningioma and drainage of intraventricular hemorrhage and intracerebral hemorrhage in the left fronto-parietal lobe. At the time of DTT scanning (5 wk after onset), he was able to move the right upper extremity against gravity. The patient exhibited an intact ideational plan for motor performance. In addition, he was able to use actual objects (scissors, eraser) using his right wrist and hand. However, he had difficulty in using his right upper extremity for pantomime of object use, imitating gestures (meaningless or meaningful), and movement of his right upper extremity proximal. Score on the ideomotor apraxia test for the right side was 4 (cut-off score < 32). DTTs for the left superior longitudinal fasciculus to the left premotor cortex and left inferior parietal lobule showed partial injury, compared with the right superior longitudinal fasciculus. These injuries appeared to be the reason for ideomotor apraxia in this patient.