Case Studies

Correct answer: The diagnosis is clearly difficult as he appears to have normal sensation and power in the hand, but is unable to use it. Thus the differential diagnosis lies between some form of functional non-neurological, psychiatric disorder, or more likely dyspraxia. Dyspraxia is a term used to describe the inability to coordinate movements in the absence of overt motor and sensory deficits.

Correct answer: The most likely site for the lesion is the posterior parietal cortex in the right hemisphere

Correct answer: The way in which one could prove the nature of the problem is to get him to do actions such as saluting, combing his hair, stirring a cup of tea, as well as copying meaningless gestures which you do with your own hand. He will probably have an inability to do either of these thus confirming the diagnosis of dyspraxia. A scan would also help if it confirmed pathology in the right posterior parietal cortex.

Correct answer: The rare condition that he may have is corticobasal degeneration, which is a progressive neurodegenerative disorder which has pathology around the central sulcus and deep within the basal ganglia. Typically patients present with a parkinsonian syndrome with marked dyspraxia and asymmetry of deficits.

Correct answer: Unfortunately there is no way of treating this syndrome as it is refractory to all known medications.