Ann Rehabil Med.  2015 Feb;39(1):150-153. 10.5535/arm.2015.39.1.150.

Novel Information on Anatomic Factors Causing Grasp Reflex in Frontal Lobe Infarction: A Case Report

• Choi I
• Jung KI
• Yoo WK
• Jang S
• Ohn SH

• KMID: 2273034
• DOI: http://doi.org/10.5535/arm.2015.39.1.150

Abstract

We report a patient with a severe limitation of function in the right hand resulting from grasp reflex following a stroke affecting the left anterior cerebral artery region. We describe, using diffusion tensor tractography (DTT), a disconnection between the bilateral frontal lobes via the corpus callosum. The patient could not control his right hand at all, even though his bilateral corticospinal tracts were intact. We noted that over the infarcted lesion on DTT, the white matter was invisible from the corpus callosum to the prefrontal cortex. These findings reflected a unique pattern of white-matter disconnection between the ipsilateral medial frontal lobe and ipsilateral and contralateral frontal cortex causing hand function deterioration in the form of severe grasp reflex.

Keyword

Grasp reflex; Frontal lobe; White matter

MeSH Terms

Anterior Cerebral Artery
Corpus Callosum
Diffusion
Frontal Lobe*
Hand
Hand Strength*
Humans
Infarction*
Prefrontal Cortex
Pyramidal Tracts
Reflex*
Stroke

Figure

• 

  Fig. 1 (A) Diffusion-weighted image of patient. Magnetic resonance imaging shows cerebral infarction in left anterior cerebral artery region including left medial frontal lobe, prefrontal cortex and substantia nigra. (B) Motor-evoked potential (MEP) amplitudes recorded in right and left first dorsal interossei (FDI) muscles. The resting MEP threshold, latency (upper panel) and increase (lower panel) were similar between the muscles. (C) Color diffusion tensor tractography (DTT) of transcallosal fibers. These fibers did not appear in the corpus callosum or left prefrontal cortex in the infarcted area (white arrows). In the color DTT, each color indicates the white-matter direction: red, anterior-posterior; blue, cephalic-caudal; green, right-left. (D) DTT of corticospinal tracts (CST). The left CST was somewhat more affected than the right (white arrow).

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