Progressive Nonfluent Aphasia With Ideomotor Apraxia and Rigidity in the Right Upper Extremity

J Korean Neurol Assoc > Volume 26(2); 2008 > Article

Journal of the Korean Neurological Association 2008;26(2): 128-132.

진행성 비유창성 실어증 환자에서 발생한 우측 팔의 경직과 행위상실증

이정석, 최재철 강사윤 강지훈

제주대학교 의과대학 신경과학교실

Progressive Nonfluent Aphasia With Ideomotor Apraxia and Rigidity in the Right Upper Extremity

Jung Seok Lee

Department of Neurology, Cheju National University Hospital, Jeju, Korea

Abstract

Background: Although levels of D-dimer and fibrinogen/fibrin degradation products (FDP) are low in the circulation of healthy individuals, their levels are significantly elevated in patients with thromboembolic diseases. The aim of this study was to investigate the clinical utilities of D-dimer and FDP in the early diagnosis of stroke subtypes and the prediction of early prognosis.
Methods: Hospitalized patients due to acute ischemic stroke underwent measurement of plasma levels of D-dimer and FDP within 12 hours after admission. Stroke severity was assessed on admission and 2 weeks later using the National Institutes of Health Stroke Scale (NIHSS). Stroke subtypes were classified according to the criteria of the Trial of ORG 10172 in Acute Stroke Treatment criterion.
Results: D-dimer and FDP levels were significantly higher in the cardioembolic group than in the atherosclerotic and lacunar groups. There was independent correlation between the level of FDP and cardioembolism. Ninety-six patients showed clinical improvement that was defined by a reduction of more than 4 points on the NIHSS two weeks later compared with that on admission. The level of D-dimer was higher in patients with clinical improvement than in patients without improvement (p=0.032). However, there was no correlation between the level of D-dimer and early improvement. A woman developed a slowly progressive speech disturbance at age 51. Three years latter she showed difficulty in calculation, reading and writing. At age 57, she complained of right shoulder pain. At age 58, neurological examination revealed rigidity, bradykinesia and ideomotor apraxia in the right upper extremity. This case demonstrats a clinical overlap between progressive nonfluent aphasia and corticobasal degenerationKeyWords:Progressive nonfluent aphasia, Corticobasal degeneration