Kasturiarachi Brittany M, Krishnaiah Balaji
Department of Neurology, University of Tennessee Health Sciences Center, Memphis, TN, USA.
Neurohospitalist. 2021 Oct;11(4):348-350. doi: 10.1177/1941874421990546. Epub 2021 Feb 3.
Aphemia, or pure motor mutism, is a phenomenon that has been reported previously in the literature and typically is associated with small infarcts in the inferior dominant precentral gyrus, pars opercularis, or inferior perirolandic gyrus. Clinically, it is important to distinguish aphemia from aphasia syndromes. Telemedicine is becoming more prevalent and involving neurologists across the country. This is an important consideration when addressing aphemic patients as many mistakes can be made during a virtual exam clouding a patient's clinical picture.
Our patient is a 61-year-old female with a past medical history of hypertension, diabetes, and an old right frontoparietal stroke without any residual deficits. She presented after her family stated that she "quit speaking" for about seven hours. Initial neurological evaluation was done via telemedicine due to the COVID-19 pandemic and was pertinent for decreased consciousness, inability to answer either orientation question, a right facial droop, and aphasia. Later it was found that the patient exhibited a pure motor mutism rather than aphasia and had an MRI lesion in the left inferior precentral gyrus.
Differentiating aphemia from aphasia is an important clinical skill for a neurologist to foster especially in the era of telemedicine. An intimate knowledge of the parts of a speech exam are vital in directing emergency staff during stroke evaluation. Additionally, distinguishing these clinical syndromes has implications with respect to prognosis and long-term rehabilitation.
运动性缄默症，即纯运动性缄默，是一种先前在文献中已有报道的现象，通常与优势侧中央前回下部、岛盖部或中央旁回下部的小梗死灶有关。临床上，将运动性缄默症与失语综合征区分开来很重要。远程医疗正变得越来越普遍，涉及全国各地的神经科医生。在诊治运动性缄默症患者时，这是一个重要的考虑因素，因为在虚拟检查过程中可能会出现许多错误，从而模糊患者的临床表现。
我们的患者是一名61岁女性，既往有高血压、糖尿病病史，曾有右侧额顶叶陈旧性卒中，无任何残留缺陷。在其家人称她“停止说话”约7小时后，她前来就诊。由于新冠疫情，最初通过远程医疗进行了神经学评估，结果显示意识下降、无法回答任何定向问题、右侧面部下垂及失语。后来发现该患者表现为纯运动性缄默而非失语，且在左侧中央前回下部有一个MRI病变。
对于神经科医生来说，尤其是在远程医疗时代，区分运动性缄默症和失语是一项重要的临床技能。熟悉言语检查的各个部分对于指导卒中评估期间的急救人员至关重要。此外，区分这些临床综合征对预后和长期康复也有影响。
