Trindade Miguel, Pinto Sílvia, Campillo José, Mesquita Teresa
Stroke Unit, Hospital Professor Fernando Fonseca, Amadora, Portugal.
Internal Medicine Department, Hospital Professor Fernando Fonseca, Amadora, Portugal.
Eur J Case Rep Intern Med. 2024 Jul 29;11(8):004710. doi: 10.12890/2024_004710. eCollection 2024.
Aphasia is a common neurocognitive disorder caused by impaired speech and language, with stroke being the most frequent cause. The neuroanatomical mechanism underlying this condition is not yet fully understood.
This case describes a 74-year-old Caucasian woman admitted with a clinical picture of right total anterior circulation infarct (TACI) and aphasia, scoring 17 on the National Institutes of Health Stroke Scale. Neuroimaging showed a large cortico-subcortical frontotemporoparietal and insular infarct involving the basal ganglia of the right hemisphere and bilateral focal atherosclerotic stenosis on the M1 segment of the middle cerebral artery. There was no left hemispheric lesion or abnormal electric activity on the electroencephalogram. A formal evaluation was compatible with transcortical motor aphasia. The aetiological study revealed atrial fibrillation, and the case was admitted as an ischaemic stroke of undetermined aetiology with two possible causes - intracranial atherosclerotic stenosis or atrial fibrillation.
Our patient fulfilled all the formal criteria for crossed aphasia in dextral (CAD): aphasia, a lesion in the right hemisphere coupled with the structural integrity of the left hemisphere, an established preference for right-hand use without a familial history of left-handedness individuals, and an absence of brain damage in childhood. Our patient's case adds to the evidence that deep structures - alone or in combination with cortical structures - are primarily affected in CAD.
The diagnostic criteria for crossed aphasia in dextral (CAD) are derived from clinical case studies and include aphasia, a lesion in the right hemisphere, a strong preference for using the right hand, the structural integrity of the left hemisphere and no history of brain damage during childhood.The right lentiform nucleus was found to be the most frequent anatomical substrate involved in CAD patients, consistent with our case description.Our patient experienced transcortical motor aphasia due to a stroke in the right hemisphere, adding to the evidence that in CAD patients, deep structures are primarily affected. In contrast, in left hemispheric lesions, cortical structures seem to be the main culprits.
失语症是一种由言语和语言功能受损引起的常见神经认知障碍，中风是最常见的病因。这种病症背后的神经解剖学机制尚未完全明确。
本病例介绍了一名74岁的白种女性，因右侧完全性前循环梗死（TACI）和失语症入院，美国国立卫生研究院卒中量表评分为17分。神经影像学检查显示，存在一个累及右侧半球基底节的大面积皮质 - 皮质下额颞顶叶和岛叶梗死灶，以及大脑中动脉M1段的双侧局灶性动脉粥样硬化狭窄。脑电图检查未发现左侧半球病变或异常电活动。正式评估结果符合经皮质运动性失语症。病因学研究发现存在心房颤动，该病例被诊断为病因不明的缺血性中风，有两种可能病因——颅内动脉粥样硬化狭窄或心房颤动。
我们的患者符合右利手交叉性失语症（CAD）的所有正式标准：失语症、右侧半球病变且左侧半球结构完整、有明确的右利手偏好且家族中无左利手个体病史、童年期无脑损伤。我们患者的病例进一步证明，在CAD中，深部结构——单独或与皮质结构联合——是主要受累部位。
右利手交叉性失语症（CAD）的诊断标准源自临床病例研究，包括失语症、右侧半球病变、强烈的右利手偏好、左侧半球结构完整以及童年期无脑损伤病史。发现右侧豆状核是CAD患者中最常受累的解剖学基础，与我们的病例描述一致。我们的患者因右侧半球中风出现经皮质运动性失语症，进一步证明在CAD患者中，深部结构是主要受累部位。相比之下，在左侧半球病变中，皮质结构似乎是主要病因。
