[A left-handed patient with disturbance of manipulating objects]

We reported a left-handed patient with the disturbance of manipulating objects and the object pantomime. The patient was a 72-year-old man, admitted to Osaka Medical College Hospital complaint of the difficulty of object manipulation. The patient was alert, well oriented and attentive. On neurological examination the patient revealed grasp reflex in his left hand. On neuropsychological examination the patient spoke fluently, but his verbal comprehension was slightly disturbed. He could name popular objects only 9 out of 20 objects. On praxis examination he could pantomime the socially accustomed movements by command visually pantomime. He did not reveal buccofacial apraxia and constructional apraxia. However, the patient could not manipulate both single and pleural objects actually and pantomime without objects. On MRI the lesion was found in both frontal lobe, right medial frontal lobe and right temporal lobe. SPECT findings demonstrated that the bilateral parietal lobes were preserved and we speculated that the right supplementary motor area was assumed to be a crucial lesion for manipulating objects in the patient.