2022 Volume 42 Issue 4 Pages 424-432
We report a case whose initial symptom of left-hand diagonistic dyspraxia changed, during the course of the disease, to right-hand compulsive manipulation of tools. The patient, a right-handed man in the late seventies, suffered a second cerebral infarction 5 days after his first cerebral infarction. A brain MRI demonstrated lesions in the left medial frontal lobe, including the supplementary motor area, as well as the genu and body of the corpus callosum. The patient presented with diagonistic dyspraxia in the left hand which interrupted his right-hand action for approximately six months. Subsequently, as the diagonistic dyspraxia disappeared, right-hand compulsive manipulation of tools became apparent instead. This is the first report in which involuntary action following focal brain damage switched from the left to the right hand. We speculate that functional reorganization of the supplementary motor area in action control contributed to the appearance of the right-hand compulsive manipulation of tools, which was initially hidden under the left-hand diagonistic dyspraxia. We further suggest that an environmental setting using visual stimuli may be an effective approach for alleviating compulsive manipulation of tools.
