Abstract
We report on a case of buccofacial apraxia without aphasia following right cerebral infarction. The patient was a 64-year-old right-handed male with no family history of left-handedness. On admission, neurological examinations revealed severe hemiplegia, sensory impairment, and hyperreflexia with pathological reflexes on the left side. Neuropsychologically he was alert and cooperative but showed severe buccofacial apraxia, mild unilateral spatial neglect, disturbance of attention and constructional disability. Aphasia and ideomotor and ideational apraxia were absent. Cranial MRI demonstrated an infarction lesion in the territory of the right middle cerebral artery. The severe buccofacial apraxia persisted even after discharge from hospital, at 5 months from the onset. Buccofacial praxis in right-handed individuals is generally considered to result from lesions in the left hemisphere and might be more closely correlated with the hemisphere responsible for speech. Reports of buccofacial apraxia in right-handed individuals following right-hemisphere damage are particularly uncommon. This case, however, suggests that the right hemisphere might have a possible role in normal buccofacial praxis and the left hemisphere might have one in language functions. This case also presented control of voluntary movements of the buccofacial muscles, which was associated neither with control of language nor with learning of complex movements of limbs.
