Kirk A, Kertesz A
Department of Clinical Neurological Sciences, Lawson Research Institute, St. Joseph's Health Centre, University of Western Ontario, London, Canada.
Brain Cogn. 1993 Jan;21(1):57-70. doi: 10.1006/brcg.1993.1004.
Constructional impairment is often considered a sign of cortical damage. However, aphasia, agraphia, and apraxia, disorders traditionally deemed cortical, have been well described following subcortical lesions, suggesting an important role for subcortical structures in cognition. Drawing impairment following subcortical lesions has not been systematically explored or compared with that following cortical damage. We examined relative incidence and severity of drawing impairment after cortical and subcortical strokes and whether there were qualitative differences between these two groups' drawings. Drawings by 125 patients with single hemispheric strokes of similar volume (42 left cortical, 36 left subcortical, 20 right cortical, 27 right subcortical) were compared using a standardized scoring system. Although previously noted right/left differences were confirmed, "subcortical drawings" did not differ from "cortical drawings" on any measures, including overall impairment. Compared with cortical patients, drawing impairment in those with subcortical lesions (especially left) was more strongly associated with impairment of other cognitive abilities. Thus, although a subcortical lesion does not cause more severe drawing impairment, subcortical lesions affecting drawing lead to more widespread cognitive dysfunction than do similarly sized cortical lesions. Drawing impairment often follows subcortical strokes and is by no means an indicator of cortical lesion localization.
构图障碍通常被认为是皮质损伤的迹象。然而，失语症、失写症和失用症，这些传统上被认为是皮质性的障碍，在皮质下病变后也有详细描述，这表明皮质下结构在认知中起重要作用。皮质下病变后的绘画障碍尚未得到系统研究，也未与皮质损伤后的绘画障碍进行比较。我们研究了皮质和皮质下中风后绘画障碍的相对发生率和严重程度，以及这两组绘画之间是否存在质的差异。使用标准化评分系统比较了125例单半球中风患者（42例左侧皮质、36例左侧皮质下、20例右侧皮质、27例右侧皮质下）的绘画，这些患者中风体积相似。尽管之前提到的左右差异得到了证实，但在包括整体障碍在内的任何指标上，“皮质下绘画”与“皮质绘画”并无差异。与皮质病变患者相比，皮质下病变患者（尤其是左侧）的绘画障碍与其他认知能力障碍的关联更强。因此，虽然皮质下病变不会导致更严重的绘画障碍，但与同样大小的皮质病变相比，影响绘画的皮质下病变会导致更广泛的认知功能障碍。绘画障碍常发生在皮质下中风后，绝不是皮质病变定位的指标。
