Endo K, Suzuki K, Yamadori A, Kumabe T, Seki K, Fujii T
Department of Rehabilitation, School of Medicine, Tohoku University.
No To Shinkei. 2001 Mar;53(3):287-92.
We report a right-handed woman, who developed a non-fluent aphasia after resection of astrocytoma (grade III) in the right medial frontal lobe. On admission to the rehabilitation department, neurological examination revealed mild left hemiparesis, hyperreflexia on the left side and grasp reflex on the left hand. Neuropsychologically she showed general inattention, non-fluent aphasia, acalculia, constructional disability, and mild buccofacial apraxia. No other apraxia, unilateral spatial neglect or extinction phenomena were observed. An MRI demonstrated resected areas in the right superior frontal gyrus, subcortical region in the right middle frontal gyrus, anterior part of the cingulate gyrus, a part of supplementary motor area. Surrounding area in the right frontal lobe showed diffuse signal change. She demonstrated non-fluent aprosodic speech with word finding difficulty. No phonemic paraphasia, or anarthria was observed. Auditory comprehension was fair with some difficulty in comprehending complex commands. Naming was good, but verbal fluency tests for a category or phonemic cuing was severely impaired. She could repeat words but not sentences. Reading comprehension was disturbed by semantic paralexia and writing words was poor for both Kana (syllabogram) and Kanji(logogram) characters. A significant feature of her speech was mitigated echolalia. In both free conversation and examination setting, she often repeated phrases spoken to her which she used to start her speech. In addition, she repeated words spoken to others which were totally irrelevant to her conversation. She was aware of her echoing, which always embarrassed her. She described her echolalic tendency as a great nuisance. However, once echoing being forbidden, she could not initiate her speech and made incorrect responses after long delay. Thus, her compulsive echolalia helped to start her speech. Only four patients with crossed aphasia demonstrated echolalia in the literature. They showed severe aphasia with markedly decreased speech and severe comprehension deficit. A patient with a similar lesion in the right medial frontal lobe had aspontaneity in general and language function per se could not be examined properly. Echolalia related to the medial frontal lesion in the language dominant hemisphere was described as a compulsive speech response, because some other 'echoing' phenomena or compulsive behavior were also observed in these patients. On the other hand, some patients with a large lesion in the right hemisphere tended to respond to stimuli directed to other patients, so called 'response-to-next-patient-stimulation'. This behavior was explained by disinhibited shift of attention or perseveration of the set. Both compulsive speech responses and 'response-to-next-patient-stimulation' like phenomena may have contributed to the echolalia phenomena of the present case.
我们报告了一名右利手女性，她在右侧额内侧叶星形细胞瘤（III级）切除术后出现非流利性失语。入住康复科时，神经系统检查发现轻度左侧偏瘫、左侧反射亢进和左手抓握反射。神经心理学检查显示她存在一般性注意力不集中、非流利性失语、失算、结构障碍和轻度口面部失用症。未观察到其他失用症、单侧空间忽视或消退现象。磁共振成像（MRI）显示右侧额上回、右侧额中回皮质下区域、扣带回前部、辅助运动区的一部分有切除区域。右侧额叶周围区域显示弥漫性信号改变。她表现出非流利性、无韵律的言语，存在找词困难。未观察到音素性错语或构音障碍。听觉理解尚可，但理解复杂指令有一定困难。命名能力良好，但类别或音素提示的言语流畅性测试严重受损。她能重复单词但不能重复句子。阅读理解因语义性错读而受到干扰，假名（音节文字）和汉字（表意文字）的书写都很差。她言语的一个显著特征是减轻的模仿言语。在自由交谈和检查过程中，她经常重复别人对她说的短语，并以此开始自己的讲话。此外，她还会重复别人对其他人说的、与她自己的谈话完全无关的单词。她意识到自己的模仿言语，这总是让她感到尴尬。她将自己的模仿言语倾向描述为极大的困扰。然而，一旦禁止模仿言语，她就无法开始讲话，且在长时间延迟后会做出错误回答。因此，她的强迫性模仿言语有助于启动她的讲话。文献中仅有4例交叉性失语患者表现出模仿言语。他们存在严重失语，言语明显减少，理解能力严重受损。一名右侧额内侧叶有类似病变的患者总体上缺乏自发性，无法对语言功能本身进行恰当检查。与语言优势半球内侧额叶病变相关的模仿言语被描述为一种强迫性言语反应，因为在这些患者中还观察到了其他一些“模仿”现象或强迫行为。另一方面，一些右侧半球有大面积病变的患者倾向于对指向其他患者的刺激做出反应，即所谓的“对下一位患者刺激的反应”。这种行为被解释为注意力的去抑制性转移或定势的持续存在。强迫性言语反应和类似“对下一位患者刺激的反应”的现象可能都导致了本例患者的模仿言语现象。
