Nedelec-Ciceri C, Anguenot A, Rosier M P, Joseph P A, Vincent D, Branchu C, Pointreau A, Latinville D
Service de Médecine B-Neurologie, Centre Hospitalier, La Rochelle.
Rev Neurol (Paris). 1996 Nov;152(11):700-3.
A 80-year-old woman, right-handed, suddenly felt the impression to be deaf. Besides, she presented language disorders of aphasic type relating to a sensorial transcortical aphasia. The case meets the diagnostic criteria for crossed aphasia. The magnetic resonance imaging showed a right temporo-parietal infarct. There was no sensorial or peripheral auditive disorder and no auditory agnosia of non verbal modality. During the evolution, the aphasic symptoms diminished partially and the subjective auditory deficit of the left ear continued. The integrated auditory evaluation (neuroacoustic test, study of auditory gnosia, dichotic listening test, evoked cortical auditory potentials) allowed the evidence of the characteristic disturbances of a right hemianacousia: loss of left hear in dichotic audition, decrease of amplitude of evoked right cortical auditory potentials. In the light of theories concerning auditory integration, one can explain this evolution. The initial aphasic comprehension disturbance expresses the alteration of the linguistic treatment of auditory information of the dominant hemisphere, here the right hemisphere. Subsequently, the linguistic disturbance regresses largely, letting persist the change of general auditory treatment. The representation of this general auditory treatment is hemispheric bilateral, the only right hemispheric damage shall result in hemianacousia.
一名80岁右利手女性突然感觉失聪。此外,她出现了与感觉性经皮质失语相关的失语型语言障碍。该病例符合交叉性失语的诊断标准。磁共振成像显示右侧颞顶叶梗死。不存在感觉性或外周听觉障碍,也没有非言语形式的听觉失认。在病程中,失语症状部分减轻,但左耳的主观听觉缺陷持续存在。综合听觉评估(神经声学测试、听觉失认研究、双耳分听测试、诱发皮质听觉电位)证实了右侧偏侧听觉失认的典型障碍:双耳分听时左耳听力丧失,右侧诱发皮质听觉电位幅度降低。根据有关听觉整合的理论,可以解释这种病程。最初的失语理解障碍表现为优势半球(此处为右侧半球)对听觉信息的语言处理改变。随后,语言障碍大多消退,而一般听觉处理的改变持续存在。这种一般听觉处理的表征是双侧半球性的,仅右侧半球受损会导致偏侧听觉失认。