2015 Volume 35 Issue 4 Pages 363-369
Here we report a case that showed disorder of new intentional motor initiation localized only in the fingers after resection of a brain tumor in the right frontal lobe. A right-handed 37-years-old male underwent a craniotomy, and a tumor located in the right superior frontal gyrus including the rostral pre-supplementary motor area (SMA) , middle frontal gyrus, cingulate gyrus and corpus callosum were resected. Postoperative magnetic resonance imaging showed an infarction in the non-tumor part of the caudal SMA-proper. Postoperatively, the patient was unable to release an object intentionally if he grasped it in his left hand. However, interestingly, in the case of extrinsic movement, when he was given a cue of movement initiation through somatic sensory stimulation, he was able to release the object easily. Moreover, paralysis, typical grasp reflex and apraxia were not observed in his left hand. The symptom recovered gradually and completely disappeared within five weeks after surgery. This symptom might be due to disorder of the inhibitory and/or promotive system of movement. However, clinical symptoms associated with disorder of the inhibitory and/or promotive system of movement are variable, and the relationship between the area of symptom manifestation and responsible lesions, as well as the neural networks related to motor symptoms, are not well known. Further studies are required with more patients with similar symptoms.
