Sato K, Sakajiri K, Komai K, Yoshikawa H, Takamori M, Notoya M
Department of Neurology, School of Medicine, Kanazawa University, Ishikawa, Japan.
No To Shinkei. 1997 Aug;49(8):765-9.
We report a case of mixed transcortical aphasia (MTA) due to multiple cerebral infarction in the dominant hemisphere in an 80-year-old right-handed woman without hemiplegia. Her spontaneous speech was markedly reduced and auditory comprehension, reading and writing were severely disturbed. Although the repetition of sentences (at most 3 words) was relatively preserved, her speech was echolalic. Brain MRI showed bilateral multiple deep white matter infarction and subcortical infarction of the left parietal lobe, including left angular gyrus, but no abnormal signal intensities were detected in either Wernicke's or Broca's area. SPECT indicated a significant decrease in mean cerebral blood flow in both hemispheres, but there was no focal hypoperfusion in either speech area. We thought that the focal hypoperfusion observed in the right cerebellum indicated crossed cerebellar diaschisis. Electroencephalogram showed a diffuse reduction in the incidence of alpha waves in the left cerebral hemisphere. From these findings, we suggest that widespread hypofunction in the dominant hemisphere was important for the occurrence of MTA.
我们报告一例80岁右利手无偏瘫女性因优势半球多发性脑梗死导致的混合性经皮质失语（MTA）。她的自发言语明显减少，听觉理解、阅读和书写严重受损。尽管句子复述（最多3个词）相对保留，但她的言语呈模仿言语。脑部MRI显示双侧多发性深部白质梗死及左侧顶叶包括左侧角回的皮质下梗死，但韦尼克区和布洛卡区均未检测到异常信号强度。单光子发射计算机断层扫描（SPECT）显示双侧大脑半球平均脑血流量显著降低，但两个言语区均无局灶性灌注不足。我们认为右侧小脑观察到的局灶性灌注不足提示交叉性小脑失联络。脑电图显示左侧大脑半球α波发生率弥漫性降低。基于这些发现，我们认为优势半球广泛的功能减退对MTA的发生很重要。
