Hagiwara H, Takeda K, Saito F, Shimizu T, Bando M
Department of Neurology, School of Medicine, Teikyo University.
Rinsho Shinkeigaku. 2000 Jun;40(6):605-10.
We report a 52-year-old right-handed man with cerebral infarction of the right anterior cerebral artery area. The MRI findings showed cerebral infarction in the trunk of the right corpus callosum, although some part of the posterior half of the trunk was spared. Some part of right precuneal gyrus, cingulate gyrus were also involved. The clinical feature of this case is characterized by following two points. First, although callosal apraxia is usually accompanied by agraphia, he showed apraxia with the left hand, but showed no agraphia. Secondary, he showed speech dysfluency mainly characterized by initial syllable repetitions. The nature of this speech dysfluency was determined as acquired stuttering. This case suggests that the pathway for praxis locates distinct portion from that for writing on corpus callosum. We analyzed callosal lesions of previous studies reporting callosal apraxia without agraphia, then compared to that of this case. And we also reviewed acquired stuttering report caused by callosal lesions. Consequently, we suggest that apraxia and stuttering were caused by damage of the trunk of the corpus callosum. While writing was preserved by the intact fibers in the posterior half of the trunk.
我们报告一例52岁右利手男性,患有右侧大脑前动脉区域的脑梗死。MRI检查结果显示右侧胼胝体干存在脑梗死,尽管胼胝体干后半部分的某些区域未受影响。右侧楔前回和扣带回的某些部分也受累。该病例的临床特征有以下两点。第一,虽然胼胝体失用症通常伴有失写症,但他表现为左手失用,却无失写症。第二,他表现出主要以起始音节重复为特征的言语不流畅。这种言语不流畅的性质被确定为获得性口吃。该病例表明,运用功能的传导通路在胼胝体上与书写功能的传导通路位于不同区域。我们分析了以往报道的无失写症的胼胝体失用症病例的胼胝体病变情况,并与本病例进行比较。我们还查阅了由胼胝体病变引起的获得性口吃的报告。因此,我们认为失用症和口吃是由胼胝体干受损所致。而书写功能因胼胝体干后半部分纤维未受损得以保留。