Engelien A, Silbersweig D, Stern E, Huber W, Döring W, Frith C, Frackowiak R S
Department of Neurology, RWTH Aachen, Germany.
Brain. 1995 Dec;118 ( Pt 6):1395-409. doi: 10.1093/brain/118.6.1395.
H2(15)O-PET was used to investigate the functional anatomy of recovery in a patient (J.B.) with bilateral perisylvian strokes and auditory agnosia, who partially regained the ability to recognize environmental sounds, but remained clinically word-deaf. The patient and a group of six normal volunteers were scanned in the following three conditions: (i) passive listening to environmental sounds; (ii) categorization of environmental sounds; (iii) at rest. In normal subjects, passive listening as compared with rest was associated with significant activations in the auditory cortices and posterior thalami, and in the inferior parietal lobe and anterior insula/frontal opercular region on the right. In J.B., activations were observed in the spared auditory cortex and inferior parietal lobe of the right hemisphere and in regions adjacent to the perisylvian lesion in the left hemisphere (anterior insula/frontal opercular region, middle temporal gyrus and inferior parietal lobe). The recovered function, as measured by categorization of sounds compared with passive listening, in J.B. was associated with bilateral activation of a distributed network comprising (pre)frontal, middle temporal and inferior parietal cortices, as well as the right cerebellum and the right caudate nucleus. In addition, there was a left-sided activation of the anterior cingulate gyrus. In normal subjects, the same categorization task led to activation of a network comprising (pre)frontal, middle temporal and inferior parietal cortices in the left hemisphere only. These results suggest that bilateral activation (with recruitment of areas homologous to those known to be responsible for normal function), the engagement of peri-infarct regions, and the involvement of a more widespread neocortical network, are mechanisms of functional reorganization after injury that may enable recovery from, or compensation for, cognitive deficits.
利用H2(15)O-PET对一名患有双侧外侧裂周中风和听觉失认症的患者（J.B.）进行研究，以探究恢复过程中的功能解剖结构。该患者部分恢复了识别环境声音的能力，但临床上仍存在词聋症状。对该患者和一组六名正常志愿者在以下三种情况下进行了扫描：（i）被动聆听环境声音；（ii）对环境声音进行分类；（iii）休息状态。在正常受试者中，与休息状态相比，被动聆听时听觉皮层、丘脑后部以及右侧顶下小叶和前岛叶/额盖区有显著激活。在J.B.中，观察到右侧半球 spared听觉皮层和顶下小叶以及左侧半球外侧裂周病变附近区域（前岛叶/额盖区、颞中回和顶下小叶）有激活。与被动聆听相比，通过声音分类测量的J.B.恢复功能与一个分布式网络的双侧激活有关，该网络包括（前）额叶、颞中回和顶下小叶皮质，以及右侧小脑和右侧尾状核。此外，前扣带回 gyrus左侧有激活。在正常受试者中，相同的分类任务仅导致左侧半球一个由（前）额叶、颞中回和顶下小叶皮质组成的网络激活。这些结果表明，双侧激活（招募与已知负责正常功能的区域同源的区域）、梗死周围区域的参与以及更广泛的新皮质网络的参与，是损伤后功能重组的机制，可能使认知缺陷得以恢复或得到补偿。
