Beach Paul A, Dhakar Monica B, Kase Carlos S
Department of Neurology, Emory University, Atlanta, GA, USA.
Neurohospitalist. 2020 Apr;10(2):121-126. doi: 10.1177/1941874419864757. Epub 2019 Jul 28.
Conventional understanding of acute onset language deficits indicates that fluent aphasias are due to perisylvian lesions in the dominant hemisphere, most often in the setting of acute stroke. Case studies and retrospective analyses, however, suggest the need to keep ictal phenomena as an alternative diagnostic possibility. The following case illustrates an epileptic mechanism of sudden onset fluent aphasia mimicking an acute stroke presentation. We utilize the case to illustrate means by which to differentiate stroke versus ictal etiology by way of electroencephalography/response to antiseizure drugs as well as perfusion/diffusion imaging. We review the literature case reports to demonstrate that isolated fluent aphasia typically localizes to left-hemispheric, temporal foci. Finally, we provide a brief synthesis of potential neurologic mechanisms by which left temporal lesions may cause fluent aphasia.
对急性起病的语言缺陷的传统认识表明，流利性失语症是由于优势半球的颞周病变所致，最常见于急性中风的情况下。然而，病例研究和回顾性分析表明，需要将发作期现象作为一种替代诊断可能性加以考虑。以下病例说明了突发流利性失语症模仿急性中风表现的癫痫机制。我们利用该病例来说明通过脑电图/对抗癫痫药物的反应以及灌注/扩散成像来区分中风与发作期病因的方法。我们回顾文献病例报告以证明孤立性流利性失语症通常定位于左半球颞叶病灶。最后，我们简要综合了左颞叶病变可能导致流利性失语症的潜在神经机制。
