Marshall R C, Gandour J, Windsor J
Audiology and Speech Pathology Service, Veterans Administration Medical Center, Portland, OR 97207.
Brain Lang. 1988 Nov;35(2):313-39. doi: 10.1016/0093-934x(88)90115-0.
A 47-year-old right-handed man underwent craniotomy for clipping of an aneurism at the trifurcation of the left middle cerebral artery. Subsequently, he suffered a left hemisphere CVA after which his speech and language resembled that of Broca's aphasia with accompanying apraxia of speech. Medical, behavioral, and acoustical data amassed over a period of several months indicated numerous contraindications to traditional diagnoses of Broca's aphasia, apraxia of speech, and dysarthria. Ultimately, it was determined that the patient had a selective impairement of phonation or laryngeal apraxia. This was illustrated dramatically when he was taught to use an electrolarynx which allowed him to bypass his disrupted phonatory system. Speaking with the electrolarynx, the patient communicated normally. Any semblance of Broca's aphasia disappeared. Supralaryngeal articulation was normal; apraxia of speech behaviors were absent. This case report indicates that dissociation of oral and laryngeal gestures due to brain injury is possible. Mechanisms underlying such a dissociation for this case are reviewed. The possibility of discrete center lesions in the frontal motor association area causing different types of apraxia of speech is discussed.
一名47岁的右利手男性接受了开颅手术，以夹闭左大脑中动脉三叉处的动脉瘤。随后，他发生了左半球脑卒，之后其言语和语言表现类似布罗卡失语症，并伴有言语失用症。在几个月的时间里积累的医学、行为和声学数据表明，传统诊断布罗卡失语症、言语失用症和构音障碍存在许多禁忌症。最终，确定该患者存在发声选择性受损或喉失用症。当他被教导使用电子喉时，这一点得到了戏剧性的体现，电子喉使他能够绕过受损的发声系统。使用电子喉说话时，患者交流正常。布罗卡失语症的任何表象都消失了。喉上发音正常；不存在言语失用行为。本病例报告表明，脑损伤导致口腔和喉部手势分离是可能的。本文回顾了该病例中这种分离的潜在机制。讨论了额叶运动联合区离散中心病变导致不同类型言语失用症的可能性。
