应用BIT检测脑血管病患者半侧空间忽视发生率

目的：应用行为忽视检查法(BIT，日本版)检测脑血管病患者的半侧空间忽视发生率，并探讨BIT检查法的适用性。方法：以22例脑血管病患者(右半球损伤16例、左半球损伤6例)为对象，进行BIT检查。结果：22例脑血管病患者的半侧空间忽视发生率为36．4％(8例)，16例右半球损伤患者的半侧空间忽视发生率为31．3％(5例)，6例左半球损伤患者的半侧空间忽视发生率为50．0％(3例)。结论：未见半侧空间忽视发生率与脑血管病患者的性别、年龄、病程、受教育年限之间有相关性。     

单侧半球损害的某些临床表现

本文对18例右利单侧半球损害患者进行神经心理学测查,发现右半球损害部分患者有左侧忽视、运动不持久和体象障碍。而左半球损害者则无上述临床表现。临床资料18例单侧半球损害的住院患者,均右利,无失语症、失用症和同向偏盲。年龄34～73岁;男14例,女4例。右半球中风13例和丘脑肿瘤1例;左半球中风4例。均为首次中风(包括脑出血和脑梗     

脸盲症一例报道并文献复习

正脸盲症,也称面孔失认症(prosopagnosia,PA),指患者知觉功能完好,但出现视觉学习和面孔识别障碍[1],包括先天遗传性和后天获得性。获得性脸盲症是指大脑后天损伤(如脑血管病、脑外伤或脑外科手术后等)引起的面孔失认。该症较罕见,文献报道仅百余例。现将我院收治1例脸盲症患者报告如下。1病例资料患者,男性,62岁。患者于2012年10月无明显诱因出现头痛,并有恶心未吐,渐出现左侧肢体活     

经颅直流电刺激在失语症康复中的应用研究进展

经颅直流电刺激(tDCS)可以有效促进脑卒中后失语症的康复。基于失语症康复三种主要假说,将tDCS应用于失语症临床治疗时,需综合考虑失语症患者大脑左半球的损伤阶段、损伤部位和损伤程度。大脑左半球核心语言功能区未受严重损伤时,宜采用tDCS兴奋大脑左半球以增强病灶周围区兴奋性,使病灶周围区发挥代偿作用;或采用tDCS抑制大脑右半球,以削弱健侧半球对患侧半球的非正常化抑制。大脑左半球核心语言功能区严重损伤时,则宜采用tDCS兴奋大脑右半球,使得大脑右半球发挥代偿作用。此外,还需考虑脑区之间白质纤维束连接是否完整,若白质纤维束受损,tDCS的治疗效果会降低。通过兴奋或抑制大脑皮层的功能,tDCS可增强大脑皮层活动的功能连接,调节脑的神经加工,进而改善失语症患者的词汇检索障碍、发音障碍,提高他们的日常口头交际能力。tDCS的治疗效果具有长期性与普遍化,但仍需进一步探究。     

大脑左右半球功能倾向测试量表的研制及应用

目的：研制大脑左右半球功能倾向测试量表,并应用于康复指导.方法：决定大脑功能有12个相关因子,决定左半球功能的相关因子为：①字母及单词的识别.②语言性声音的辨别.③复杂随意运动的控制.④词语记忆.⑤听说读写.⑥数学能力.决定右半球功能的相关因子为：①复杂图形及相貌的识别.②环境声音,音乐的辨别.③复杂形状的触觉识别.④运动模式的空间组织.⑤形状记忆.⑥几何学,方向感觉.针对每个因子,经过不断实践、总结,分别予11或12道题目以测试,综合起来,构成测试量表.于2003-04作者用此量表对江苏省靖江市随机选择的一所普通中学和一所国家级重点中学的在校学生进行测试,分3个年级组,初一年级组357例;初二年级组541例;高一年级组806例.并作相关统计.结果：共发出1 704份测试量表,回收1 704份,有效率100%.①各年级组大脑左右半球功能进行对比,差异有显著性（t=5.253,8.940,15.991,P均＜0.01）.②各年级组大脑左右半球功能的正态分布检验,P值介于0.143～0.307,差异无显著性,故呈正态分布.③各年级组大脑功能的12个相关因子的正态分布检验,P值介于0.101～0.523,差异无显著性,呈正态分布.④大脑右半球功能的相关因子中,相关系数最大的是“运动模式的空间组织”（r=0.767）,其次是“环境声音,音乐的辨别”（r=0.739）、“几何学,方向感觉”（r=0.718）、“复杂形状的触觉识别”（r=0.715）、“形状记忆”（r=0.711）、“复杂图形及相貌的识别”（r=0.694）;左半球功能的相关因子中,相关系数最大的是“数学能力”（r=0.755）,其次是“听说读写”（r=0.709）、“字母及单词的识别“（r=0.700）、“词语记忆”（r=0.695）、“语言性声音的辨别”（r=0.685）、“复杂随意运动的控制”（r=0.636）.结论：大脑半球功能及12个相关因子的得分均呈正态性分布.在12个相关因子中,决定右半球功能最重要的是“运动模式的空间组织”,决定左半球功能最重要的是“数学能力”.大脑左右半球功能倾向测试量表具有合理性.可以指导学习障碍、脑血管病等患者训练大脑功能,以促进大脑左右半球功能协调发展,促进脑功能的康复.     

维吾尔语和汉语双语失语症的临床研究

为探讨维吾尔语和汉语双语失下特点及春机制,按北京医科大学《汉语失语检查法》对５４例病前掌握维吾尔语和汉旗号珠脑血管病双语失语患者进行检查,结果：运动性 语症（２５例）和皮质下双语失语症（２４例）最多,经皮质性双语失语症、感觉性双语失语症和完全性双语失语症最多。双语失语症自然恢复以平行性恢复和连续性恢复为主。出生脑血管病的失语症比缺血性脑血管病恢复好。提示（１）神经语言功能存在跨文化和民族差异,并认     

脑卒中后汉语语法缺失与脑损害区域的关系

背景约1/3的脑损害患者存在不同程度的语言功能受损或丧失,其中大部分存在不同程度的语法缺失.目前,关于汉语语法加工究竟由左半球或右半球还是两半球共同参与完成的尚不清楚.目的探讨脑卒中后汉语语法缺失与脑损害区域的关系,为脑卒中后汉语语法缺失患者的语言康复提供理论依据.设计病例-对照分析.对象收集2001-10/2002-08武汉大学附属人民医院住院的脑卒中患者60例,所有患者均首次发病,经颅脑CT检查证实为左或右半球单发病灶.根据病灶所在侧分为左半球脑卒中组和右半球脑卒中组各30例.正常对照组为30名既往无脑器质性疾病史和神经系统症状、体征的健康志愿者.方法先用标准汉语失语检查法检查语言,初步确定有无语法障碍;然后应用汉语语法量表(包括词类、语序、语用、句子-图画匹配、语言符号操作等)对3组被试者进行测试,利用统计学结果分析汉语语法缺失与CT所示脑损害区域的关系及意义.应用计算机图像处理技术对20例汉语语法缺失患者的颅脑CT图像进行标准化处理,观察病变的集中趋势.主要观察指标①汉语语法量表评估结果.②CT图像标准化处理结果.结果按意向处理分析,90名被试者全部进入结果分析.①汉语语法量表评估结果左半球脑卒中组患者的词类、语序、语用、句图匹配和语言符号操作评分显著低于右半球卒中组和正常对照组(P＜0.01),右半球脑卒中组仅句-图匹配项低于正常对照组(79.73±13.67,1.76±7.78,P＜0.01),其他项目差异无显著性意义(P＞0.05).②CT图像标准化处理后,病变部位主要集中在左额叶和左颞叶.结论左额-颞叶神经网络系统损伤与汉语语法缺失密切相关,右额-颞叶神经网络系统参与句法辅助加工,完整的汉语语法认知需要大脑两半球的协同活动.     

急性脑血管病患者汉语语法缺失的词类理解障碍

目的探讨左半球急性脑血管病患者汉语语法缺失的词类理解障碍特点及其可能存在的相关机制. 方法采用<汉语失语检查法>及<汉语语法量表>中的词类测试任务和语言符号操作任务对存在汉语语法缺失的30例左半球急性脑血管病患者和30例正常对照者进行测试. 结果 2组受试者在词类及语言符号操作两项总分成绩间差异均有统计学意义(P<0.01),其中词类中的虚词、量词、复数"们"的测试成绩2组间差异有统计学意义(P<0.01),而名词、形容词、动词及代词2组间差异无统计学意义(P>0.05);在语言符号操作项目中,2组的实质词成绩差异无统计学意义(P>0.05),而功能词的成绩组间差异有统计学意义(P<0.01). 结论存在汉语语法缺失的左半球急性脑血管病患者在词类理解方面具有一定选择性的功能缺损,其相关机制可能与功能词类阶层破坏及功能词的异常加工有关.     

偏瘫患者失认症和失用症的康复

目的　观察康复训练对偏瘫患者失认症和失用症的疗效。方法　对 75例偏瘫患者按失认症和失用症量表进行评定 ,观察各类失认症所占的比例 ,对存在失认症或失用症的患者进行有针对性的康复训练 ,每日训练 1次 ,每次 30min ,1～ 3个月为 1个疗程 ,疗程前后分别进行评价。结果75例偏瘫患者有 2 1例存在失认或失用 ,阳性率为 2 8%。康复治疗前后两次评价结果 ,分别为32 .5 6± 3.12和 45 .0 2± 2 .72 ,差异有显著性 (P <0 .0 5 ) ,说明失认症、失用症患者经过系统的康复训练 ,疗效确切。结论　偏瘫患者中 ,失认症、失用症存在一定的比例 ,应列为常规检查 ,早期发现 ,及时康复治疗     

大脑左右半球功能倾向测试量表的研制及应用

目的:研制大脑左右半球功能倾向测试量表,并应用于康复指导。方法:决定大脑功能有12个相关因子,决定左半球功能的相关因子为:①字母及单词的识别。②语言性声音的辨别。③复杂随意运动的控制。④词语记忆。⑤听说读写。⑥数学能力。决定右半球功能的相关因子为:①复杂图形及相貌的识别。②环境声音,音乐的辨别。③复杂形状的触觉识别。④运动模式的空间组织。⑤形状记忆。⑥几何学,方向感觉。针对每个因子,经过不断实践、总结,分别予11或12道题目以测试,综合起来,构成测试量表。于2003-04作者用此量表对江苏省靖江市随机选择的一所普通中学和一所国家级重点中学的在校学生进行测试,分3个年级组,初一年级组357例;初二年级组541例;高一年级组806例。并作相关统计。结果:共发出1704份测试量表,回收1704份,有效率100%。①各年级组大脑左右半球功能进行对比,差异有显著性(t=5.253,8.940,15.991,P均<0.01)。②各年级组大脑左右半球功能的正态分布检验,P值介于0.143～0.307,差异无显著性,故呈正态分布。③各年级组大脑功能的12个相关因子的正态分布检验,P值介于0.101～0.523,差异无显著性,呈正态分布。④大脑右半球功能的相关因子中,相关系数最大的是“运动模式的空间组织”(r=0.767),其次是“环境声音,音乐的辨别”(r=0.739)、“几何学,方向感觉”(r=0.718)、“复杂形状的触觉识别”(r=0.715)、“形状记忆”(r=0.711)、“复杂图形及相貌的识别”(r=0.694);左半球功能的相关因子中,相关系数最大的是“数学能力”(r=0.755),其次是“听说读写”(r=0.709)、“字母及单词的识别”(r=0.700)、“词语记忆”(r=0.695)、“语言性声音的辨别”(r=0.685)、“复杂随意运动的控制”(r=0.636)。结论:大脑半球功能及12个相关因子的得分均呈正态性分布。在12个相关因子中,决定右半球功能最重要的是“运动模式的空间组织”,决定左半球功能最重要的是“数学能力”。大脑左右半球功能倾向测试量表具有合理性。可以指导学习障碍、脑血管病等患者训练大脑功能,以促进大脑左右半球功能协调发展,促进脑功能的康复。     

不同脑半球损伤患者认知功能障碍的比较

目的探讨左、右大脑半球损伤患者在认知功能障碍方面的特点。方法用失语症筛查表、洛文斯顿作业疗法用认知评定成套测验 (LOTCA)对 5 5例左脑损伤患者和 43例右脑损伤患者的认知功能进行评定。结果右脑损伤患者组在地点定向、重叠图形识别、空间知觉、运用能力等方面的成绩明显高于左脑损伤患者组 (P <0 0 0 1— 0 0 0 5 ) ,而在形状视认、视运动组织等方面的成绩则明显低于左脑损伤患者组 (P <0 0 0 1— 0 0 2 ) ;右脑损伤后出现时间定向障碍、形状失认、图形背景分辨障碍、单侧忽略、注意力障碍的可能性明显多于左侧脑损伤 (P <0 0 0 5— 0 0 2 5 ) ,而出现失语、意念运动性失用的可能性明显少于左侧脑损伤 (P <0 0 0 5— 0 0 1) ;左右脑损伤后出现地点定向障碍、物体失认、颜色失认、空间失认、运用失用、结构性失用、思维障碍等方面的可能性无明显差异 (P >0 0 5 )。结论左右脑损伤后患者出现的认知功能障碍有其特征性表现     

Bilateral impairment of somesthetically mediated object recognition in humans

Thirty adult patients (six in each of five groups--neurologically normal, lacunar infarct-related hemiparesis, unilateral thalamic lacunar infarction, right cortical infarction with mild left hemineglect, and extensive right cortical infarction with severe left hemineglect) were asked to perform various tasks that encompassed basic and intermediate somatosensory functions and tactile and visual object recognition. Patients with thalamic and cortical infarctions had severe impairment of contralateral hand-mediated somatosensory functions in all three categories of somesthetic tasks, although patients with cortical infarction were more impaired on the object recognition task than were patients with thalamic infarction. Patients with extensive damage to the right hemisphere and severe left hemineglect also had impairment of somesthetically mediated object recognition in the ipsilateral hand despite normal basic and intermediate somatosensory function and visually mediated object recognition analogous to unilateral tactile agnosia. All other groups had normal ipsilateral tactile object recognition.     

Anosognosie de l’hémiplégie, personnification de la main paralysée et image du corps

Psychological theories relating to anosognosia for hemiplegia generally suggest that anosognosic patients deny their hemiplegia in order to protect their self-image or avoid negative emotions: that a person tries to deny, refuse or forget hemiplegia, a major handicap, seems an understandable attitude. The psychological theories concerning anosognosia thus imply that psychological reactions to hemiplegia are not affected by the causal cerebral lesions. These interpretations do not account either for the link between right hemisphere lesions and anosognosia or for the links between anosognosia, body schema disorders and specific characteristics of the patients’ discourse when describing their paralysed limbs. The psychoanalytical conception of the links between self-representation and body image enables us to apprehend anosognosia as a neurological pathology of body image.     

偏盲否认症临床分析

目的探讨偏盲否认症的临床特点、发病机制和大脑半球病变的联系。方法对 1 6例脑梗死所致的同位性视野缺损患者 ,进行视野、智能筛查和详细的偏盲认知、视觉疏忽的神经心理学检查 ,结合MRI或CT的病灶定位进行分析研究。结果 1 6例患者中有 1 0例存在偏盲否认症 ,其中 1 3例右侧脑梗死患者中 8例出现偏盲否认症 ,3例左侧脑梗死患者中 2例出现偏盲否认症 ;6例非偏盲否认症患者中 3例存在偏侧视觉忽视。 1 0例偏盲否认症中 ,7例为大脑中动脉供血区较大面积梗死 ,3例为枕叶或颞枕交界处小灶梗死。结论视觉认知过程在大脑皮层中没有固定的特殊区域 ,其通过多个皮层及皮层下结构协同完成 ;双侧大脑半球均与视觉认知过程有关     

左侧空间忽略患者关联性注意捕捉效应的研究

目的:探讨脑损伤后致左侧空间忽略患者的注意捕捉效应。方法:本研究对右侧大脑半球损伤伴左侧忽略的患者及健康被试各20例,分别进行神经心理学背景测试及关联性注意捕捉效应测试,观察左侧空间忽略患者与健康被试之间注意捕捉效应的差异,分析影响关联性注意捕捉效应强度的因素。结果:①与健康对照组相比,左侧空间忽略组的数字捕捉正确率明显降低(P<0.01)。②健康对照组:无论干扰刺激颜色与目标刺激颜色是否一致,左侧视野出现干扰刺激时的数字捕捉正确率均明显低于右侧视野出现干扰刺激时(P<0.01);无论干扰刺激在目标刺激的左侧或右侧,当干扰刺激颜色与目标刺激颜色一致时,数字捕捉正确率低于干扰刺激颜色与目标刺激颜色不一致时(P<0.01,0.05)。③左侧空间忽略组:无论干扰刺激颜色与目标刺激颜色是否一致,右侧视野出现干扰刺激时的数字捕捉正确率均低于左侧视野出现干扰刺激时(P<0.05);左侧视野出现的干扰刺激颜色与目标刺激颜色一致或不一致时,对数字捕捉正确率的影响差异无统计学意义,而右侧视野出现的干扰刺激颜色与目标刺激颜色一致时,数字捕捉正确率低于颜色不一致时(P<0.05)。结论:左侧空间忽略患者的注意功能下降,但无论对于健康受试者或者左侧空间忽略患者,符合目标刺激颜色特征的干扰刺激均能够增强非随意性地注意捕捉效应。     

Rediscovering tactile agnosia

Eighty-four patients with damage to various levels of the nervous system, ranging from the peripheral nerves to the cerebral cortex, underwent somesthetic assessment in order to determine the degree to which basic and complex perceptual and motor disorders affect tactile object recognition (TOR) and to determine whether TOR can be impaired in the absence of more basic sensorimotor imperception. The results suggest that (1) basic and intermediate disorders of somesthetic function impair TOR but are commensurately more severe for any given degree of TOR impairment in patients with peripheral lesions than in patients with cortical lesions; (2) neither hemiparesis nor hemianopia alone precludes normal TOR; (3) hemineglect contributes substantially to TOR impairment; (4) impairment of TOR can occur in the absence of more basic somesthetic dysfunction and constitutes tactile agnosia; (5) tactile agnosia is a subtle, nondisabling disorder that should be distinguished from the nonagnosic, severe and disabling disorder, astereognosis; and (6) tactile agnosia results from unilateral damage to parietotemporal cortices, possibly including the second somatosensory cortex, in either hemisphere.     

Dynamic Spatial Coding within the Dorsal Frontoparietal Network during a Visual Search Task

To what extent are the left and right visual hemifields spatially coded in the dorsal frontoparietal attention network? In many experiments with neglect patients, the left hemisphere shows a contralateral hemifield preference, whereas the right hemisphere represents both hemifields. This pattern of spatial coding is often used to explain the right-hemispheric dominance of lesions causing hemispatial neglect. However, pathophysiological mechanisms of hemispatial neglect are controversial because recent experiments on healthy subjects produced conflicting results regarding the spatial coding of visual hemifields. We used an fMRI paradigm that allowed us to distinguish two attentional subprocesses during a visual search task. Either within the left or right hemifield subjects first attended to stationary locations (spatial orienting) and then shifted their attentional focus to search for a target line. Dynamic changes in spatial coding of the left and right hemifields were observed within subregions of the dorsal front-parietal network: During stationary spatial orienting, we found the well-known spatial pattern described above, with a bilateral hemifield representation in the right hemisphere and a contralateral preference in the left hemisphere. However, during search, the right hemisphere had a contralateral preference and the left hemisphere equally represented both hemifields. This finding leads to novel perspectives regarding models of visuospatial attention and hemispatial neglect.     

Activation of the human posterior parietal and temporoparietal cortices during audiotactile interaction

We recorded cortical-evoked responses with a whole-scalp neuromagnetometer to study human brain dynamics associated with audiotactile interaction. The subjects received unilateral auditory (A) or tactile (T) stimuli, or both stimuli simultaneously (AT), alternating to the left and right side. Responses to AT stimuli differed significantly from the algebraic sum of responses to A and T stimuli (A + T) at 75-85 and 105-130 ms and indicated suppressive audiotactile interaction. Source modeling revealed that the earlier interaction occurred in the contralateral posterior parietal cortex and the later interaction in the contralateral parietal opercula between the SII cortex and the auditory cortex. The interaction was significantly stronger in the left than the right hemisphere. In most subjects, AT responses were far more similar to T than to A responses, suggesting suppression of auditory processing during the spatially and temporally concordant audiotactile stimuli in which the tactile component was subjectively more salient.     

Hemispheric Specialization in Dogs for Processing Different Acoustic Stimuli

Considerable experimental evidence shows that functional cerebral asymmetries are widespread in animals. Activity of the right cerebral hemisphere has been associated with responses to novel stimuli and the expression of intense emotions, such as aggression, escape behaviour and fear. The left hemisphere uses learned patterns and responds to familiar stimuli. Although such lateralization has been studied mainly for visual responses, there is evidence in primates that auditory perception is lateralized and that vocal communication depends on differential processing by the hemispheres. The aim of the present work was to investigate whether dogs use different hemispheres to process different acoustic stimuli by presenting them with playbacks of a thunderstorm and their species-typical vocalizations. The results revealed that dogs usually process their species-typical vocalizations using the left hemisphere and the thunderstorm sounds using the right hemisphere. Nevertheless, conspecific vocalizations are not always processed by the left hemisphere, since the right hemisphere is used for processing vocalizations when they elicit intense emotion, including fear. These findings suggest that the specialisation of the left hemisphere for intraspecific communication is more ancient that previously thought, and so is specialisation of the right hemisphere for intense emotions.     

脑血管意外后空间方位和时间词句的听理解研究

运用空间方位词、时间词对４５例正常成人、３１例右半球脑血管意外病人、２０例左半球脑血管意外无失语病人和２０例左半球脑血管意外失语病人进行了听理解测验。结果表明，失语组、右半球病变组的空间方位词句测验成绩与对照组有差异，而且失语组与右半球病变组的成绩也有差异。失语组时间词句的听理解成绩与其它三组的成绩有差异。结果表明失语组的是否句与语段成绩无差异；可逆被句、方位词句、时间词句的成绩无差异。但是否句、语段与可逆被动句、方位词句、时间词句的成绩有差异。认为失语组听理解是否句、语段较理解可逆被动句、方位词句、时间词句容易。失语组倾向于按事件发生的时间顺序理解时间词句。