Ogawa Katsuhiko, Tamura Masato, Shinbo Satoru, Mizutani Tomohiko
Department of Neurology, Nagaokanishi Hospital, 371-1 Mitsugoya-cho, Nagaoka, Niigata 940-2111, Japan.
No To Shinkei. 2002 Apr;54(4):331-5.
We report a 72-year-old right-handed man who was diagnosed as having crossed aphasia. He had polycythemia, hypertension and an old cerebral infarction in the right occipital lobe. He was admitted to our hospital because of muscle weakness in the left extremities at the age of 71. In the laboratory data, red blood cells(689 x 10(4)/microliter) and platelets(87.6 x 10(4)/microliter) were increased in number. Brain CT detected a right putaminal hematoma and an old infarct in the occipital lobe on the right. After admission, he developed non-fluent speech, and impairments of auditory comprehension, writing and naming due to the infarction in his right cerebral hemisphere including the middle cerebral artery distribution. The standard language test of aphasia(SLTA) revealed marked impairments in the language function, except for reading kana and kanji words. This writing was severely impaired compared with other language dysfunctions. Auditory comprehension, repetition and reading were impaired at the sentence level rather than at the kana word level. Furthermore, he suffered from left hemiparesis and left unilateral spatial neglect. We diagnosed his impairments of language function as crossed aphasia based on his right-handedness, CT findings and the results of SLTA. His language center was considered to be located in both cerebral hemispheres. Compared with typical findings in reported cases of crossed aphasia, the presence of both non-fluent speech and mutism were consistent with previous observations. However, the marked impairments of auditory comprehension, repetition and naming were different. Polycythemia and hypertension were considered to be the risk factors of cerebral infarction in our patient.
我们报告了一名72岁的右利手男性，他被诊断为交叉性失语。他患有红细胞增多症、高血压以及右侧枕叶陈旧性脑梗死。他在71岁时因左侧肢体肌无力入住我院。实验室检查数据显示，红细胞数量（689×10⁴/微升）和血小板数量（87.6×10⁴/微升）增加。脑部CT检测到右侧壳核血肿以及右侧枕叶陈旧性梗死灶。入院后，由于其右侧大脑半球包括大脑中动脉分布区域的梗死，他出现了非流畅性言语，以及听觉理解、书写和命名障碍。失语症标准语言测试（SLTA）显示，除了阅读假名和汉字单词外，其语言功能存在明显障碍。与其他语言功能障碍相比，其书写功能严重受损。听觉理解、复述和阅读在句子层面而非假名单词层面受到损害。此外，他还患有左侧偏瘫和左侧单侧空间忽视。基于他的右利手、CT检查结果以及SLTA的结果，我们将他的语言功能障碍诊断为交叉性失语。他的语言中枢被认为位于双侧大脑半球。与报道的交叉性失语病例的典型表现相比，非流畅性言语和缄默症的存在与先前的观察结果一致。然而，听觉理解、复述和命名的明显障碍有所不同。红细胞增多症和高血压被认为是我们这位患者脑梗死的危险因素。
