右侧皮质分水岭梗死致交叉性失语1例报告

交叉性失语是指任何利手同侧大脑半球病变引起的失语,目前仅指右利手者右侧大脑半球受损所致的失语症,临床少见.现报告1例右侧皮质分水岭梗死致交叉性失语如下. 1 病例 男,57岁.因"突发左半身无力伴言语不清3h"于2011年3月11日入院.患者于3h前活动中突发左半身无力伴言语不清,症状持续存在.患者发病前语言功能正常,除汉语外不会其他语言.无左利手家族史.     

汉语失语症患者的语言大脑优势侧与利手的关系

对309例急性期(3个月以内)脑梗塞(225例)和脑出血(84例)患者进行了失语症检查及利手的测定,结果为语言正常患者170例(占55.02％),确诊为各型(10型)失语症的患者139例(占44.98％)。失语症患者中右利手134例(96.40％),非右利手5例(3.60％)。左大脑半球病灶失语症患者136例(97.84％),其中右利手者131例(94.24％),非右利手者5例(3.60％)。右大脑半球病灶右利手者仅3例(2.16％),为交叉性失语。表明中国汉人无论是右利手还是非有利手,其语言优势侧仍以在左大脑半球者为多数,与西方人无根本差别。     

急性脑梗死后失语症的MRI影像学研究

目的:应用MRI检查确定急性脑梗死后失语症类型与脑梗死部位之间的关系。方法:对68例急性脑梗死后具有失语症表现患者应用汉语失语成套测验中的利手评定标准进行利手判定和汉语失语症检查进行失语症的分类,用头颅MRI确定患者的脑梗死部位及病灶体积。结果:68例急性脑梗死失语症患者均为右利手,失语症类型分别为完全性失语18例,运动性失语25例,感觉性失语7例,传导性失语7例,经皮质运动性失语7例,命名性失语4例。累及经典语言中枢的有32例,36例为非语言中枢受累。结论:急性脑梗死失语症类型与传统的失语症解剖定位不完全符合,非语言中枢梗死也可引起失语症。     

交叉性失语(附5例病例分析)

目的通过临床病例分析,回顾性探讨交叉性失语类型、可能的发生机制及预后。方法5例右利手右侧病变引起失语的患者均进行汉语失语成套测验中的口语流利性评定、西部失语评定及波士顿诊断性失语严重程度分级标准进行失语症严重程度分级,采用Frenchy构音障碍评定标准进行构音障碍评定;语言康复训练30d后,采用上述方法进行语言能力复查。结果5例病例均符合交叉性失语的诊断标准,经康复训练后,语言功能恢复较好。结论交叉性失语有两种类型:镜像失语及非典型失语,其可能的发生机制为:(1)右半球新的病灶使左半球处于静止或没有被发现的病灶,在某种程度上出现症状;(2)利手的同侧半球控制;(3)双侧半球均具有语言功能;(4)语言功能侧化停止于某一发展阶段。交叉性失语症预后好。     

性别、年龄、卒中类型与卒中后失语症类型的相关性分析

【摘要】
目的 本文旨在探讨性别、年龄、卒中类型和卒中后失语症分类间的关系。
方法 回顾性分析2005年7月～2012年7月首都医科大学附属北京天坛医院收治的符合病例入排标准的421例急性卒中患者,应用北京大学第一医院神经内科汉语失语检查法中的利手评定标准进行利手判定、西部失语成套测验进行失语症的分类及失语指数（Aphasia Quotient,AQ）评分,按照年龄不同分为青、中、老年三组,按卒中类型分为脑梗死及脑出血,结合不同性别观察失语症类型的分布情况,比较不同年龄、性别以及卒中类型间失语症类型分布有无差异。
结果 入选患者均为右利手,男性占69.60%,女性占30.40%。失语症类型如下：运动性失语116例（男85例,女31例）,感觉性失语35例（男20例,女15例）,传导性失语15例（男10例,女5例）,经皮质运动性失语63例（男50例,女13例）,经皮质感觉性失语11例（男8例,女3例）,经皮质混合性失语27例（男13例,女14例）,命名性失语73例（男47例,女26例）,完全性失语81例（男60例,女21例）,经统计学分析,男性卒中后失语症发生率（69.60%）明显高于女性（30.40%）（χ2=11.57,P=0.003）,尤以青中年（≤65岁）为主（73.38%）,老年期（>65岁）女性发生率逐渐升高（42.97%）,与男性差异逐渐缩小（26.28%）;性别对失语症类型无明显影响（χ2=13.84,P=0.054）,男女患者均以运动性失语最常见（分别为29.01%、24.22%）;各年龄组患者失语类型分布无明显差异（χ2=14.94,P=0.382）。脑梗死所致失语症患者较脑出血所致者更为多见（分别为306例和115例）,但在失语症类型分布上差异无显著性（χ2=13.23,P=0.067）,除女性脑出血患者外,均以运动性失语最为常见（分别为29.82%,29.55%,26.67%）。
结论 年龄、性别及卒中类型对卒中后失语症类型分布均无明显影响,男性卒中后失语发生率明显高于女性且患病平均年龄小于女性,两性中均以运动性失语最常见;除去女性脑出血患者外,均以运动性、完全性及命名性失语最常见。     

交叉性失语的研究进展

交叉性失语是一组由于右利手者右侧大脑半球损伤引起的获得性语言障碍综合征，在卒 中患者中的发病率为0.38%～4.6%，包括镜像失语与非典型失语，口语表达障碍多数为非流利性失语。 交叉性失语的发病机制目前仍存在争议，越早进行康复训练，预后越好。本文从交叉性失语的发病 机制、临床特点、影像学检查及康复训练的研究进展进行综述，以提高临床医师的重视，从而为交 叉性失语的诊治提供理论依据。     

急性脑梗死导致特殊类型失语临床分析

目的观察急性脑梗死所致几种特殊类型失语症患者的语言特点。方法分别在发病1 w、4 w采用中国康复研究中心的汉语标准失语症检查表对遴选患者进行评价,并完善留存影像学资料。其中包括1例纯词哑、2例交叉性失语、1例基底节性失语及1例丘脑性失语。结果少数急性脑梗死患者失语症类型、神经影像学检查所见的病变部位并不完全符合经典的失语症模式。结论经典语言中枢以外的更多部位可能参与失语症的形成。     

维吾尔语失语症与脑卒中病变部位关系的临床研究

目的 分析脑卒中后维吾尔语失语症类型与病变部位的关系.方法 选择符合入选标准的脑卒中后维吾尔语失语症患者52例,应用改良的失语检查法进行失语症的评定,并在入院后1w内完成头部CT或MRI检查.结果 52例患者中,运动性失语24例,完全性失语12例,命名性失语4例,基底节性失语4例,经皮质运动性失语4例,感觉性失语2例,混合性失语1例,经皮质感觉性失语1例.病变部位位于经典语言中枢的30例,占57.69％.结论 脑卒中后维吾尔语失语症类型与病变部位有一定关系,部分与经典的语言中枢一致.     

经皮质感觉性失语的临床与CT损害部位的关系

本文对4例经颅脑CT显示左大脑半球梗塞的右利手患者进行了语言检查,结果均符合经皮质感觉性失语(TCSA)。认为左颞枕结合区,尤其是颞中回及深部白质区,有一特定的脑功能系统。该系统损伤导致以复述功能保留、词语理解障碍、找词困难、命名障碍为特征的经皮质失语。语言障碍的程度和恢复与脑病变的部位有着密切的关系。     

右利手右大脑半球卒中患者的镜像书写研究

目的探讨右利手患者右大脑半球卒中时的镜像书写发生情况及其发生机制。方法对经ＣＴ确诊的右利手右大脑半球卒中患者按《汉语失语症检查法（草案）》进行检查，其中１３例左侧轻瘫者进行左手书写检查，并检查了左右定向力和视空间能力。结果１３例左手书写的患者中，６例出现镜像书写，占４６．１％，２例为中度，４例为轻度。２例中度镜像书写者左右定向差，６例患者均无视空间障碍。间隔２周以上复查，均有明显恢复或消失。结论①非优势半球病变可引起镜像书写，其发生率与优势半球卒中相仿；②认为右半球卒中阻断了左侧书写运动－图式对右侧镜像书写运动－图式的抑制及对右侧运动区书写运动的主导作用而产生镜像书写，提出镜像书写运动联系通路理论。左右定向障碍对镜像书写的发生也有一定作用；③视空间障碍与镜像书写似无明显关系。     

Crossed aphasia in right-handed patients. I. Review of the literature

More than 70 cases of crossed dextral aphasia have been reported in the literature since the end of the XIXth century. If a genetic, environmental or even pathological factor--or lack of information about it--could be suspected to be responsible of a majority of these cases, 10 of them in which all these factors were eliminated still remain. A summary of the neurological, neuropsychological and neurolinguistic features of these 10 cases shows, among other things: 1. that nearly all of them present a (left) motor deficit associated with a quite large and deep right-hemispheric lesion; 2. that most of them also report the presence of one or the other of the neuropsychological signs usually seen in right hemisphere lesions in dextrals; 3. that if reduction and agrammatism are frequent aphasic signs, fluent jargon is also reported, more so in written than in oral expression. Some of the hypotheses put forward to explain crossed aphasia in dextrals are discussed in the light of these facts. It appears that none of these hypotheses can satisfactorily account for the occurrence of a right hemisphere aphasia in some dextrals.     

Transcortical sensory aphasia due to extensive infarction of left cerebral hemisphere]

We report a case of transcortical sensory aphasia occurred after extensive infarction of left cerebral hemisphere. A 68-year-old, right-handed man with atrial fibrillation suddenly developed cerebral embolism of left middle cerebral artery. He was treated conservatively, and the right hemiplegia, aphasia, apraxia in a slight degree and right hemispatial neglect in a slight degree consequently existed. MRI showed a large cortical and subcortical infarct lesion including the left Broca's area, central region, perisylvian area with Wernicke's area and temporal lobe. In contrast, neuropsychological evaluation using the Western Aphasia Battery (WAB) demonstrated transcortical sensory aphasia, e.g., fluency 8, auditory comprehension 1. repetition 10 and object naming 2.4. In addition to preserved repetition, both linguistic prosody and affective prosody were well preserved. Most cases with transcortical sensory aphasia are known to occur with the lesion including temporo-parieto-occipital junction of dominant hemisphere. Our patient and a few other reported cases of transcortical sensory aphasia had a lesion in perisylvian area including Wernicke's area. Therefore, it is possible that their minor hemisphere worked selectively for repetition. Furthermore, we suggest that this patient presented dissociative aphasia that all the process of repetition and the function of linguistic and emotional prosody were represented in the right hemisphere and the other functions including comprehension of word meanings were existed in the left hemisphere. We believe that our case of transcortical sensory aphasia with dissociative aphasia gives a suggestion about the mechanism and localization of repetition and prosody in the whole system of language.     

Absence of aphasia in a dextral with a left hemisphere lesion: A case report

Abstract

Right-handed patients with aphasia due to a right hemisphere lesion, or sinistral aphasics with a left hemisphere lesion, are referred to as crossed aphasics (Bramwell 1899). Since left damaged sinistrals with aphasia are the rule (Brown and Hecaen 1976), it is the dextral with a right hemisphere lesion that has received most of the attention. When we reviewed the topic of crossed aphasia in dextrals some years ago in relation to a case report (Brown and Wilson 1973). only seven other cases could be found that satisfied the minimal criteria of a clearcut aphasia dextrality and a negative family history ofleft handedness, but since this paper there have been many additional observations (e.g. Assal, Perentes and Dervaz 1981, Donoso, Santander and Pavez 1984, Pillon, Desi and Lhermitte 1979, Wechsler 1976; see Joanette, Puel, Nespoulos, Rascol and Lecours [1982] and Castro-Caldas and Confraria [1984] for review).     

Reversed laterality of cerebral functions in a non-right-hander: neuropsychological and spect findings in a case of 'atypical' dominance.

A 54-year-old non-right-handed man with positive familial sinistrality showed a pure right hemisphere syndrome following a left hemisphere stroke. Severe right side hemineglect, transcortical motor dysprosodia, spatial dysgraphia and visuo-constructive impairments were observed. At no time were the expected left hemisphere abnormalities such as aphasia, alexia, right-left disorientation or finger agnosia noted. A left fronto-temporal subcortical lesion was documented on CT scan. A Tc-99m HM-PAO SPECT study revealed no cerebral blood flow changes in the right hemisphere while in the left hemisphere a fronto-temporo-parietal cerebral blood flow reduction was evident. This case of a complete reversed laterality of cognitive functions argues for a distinction to be made between 'anomalous' cerebral dominance and 'atypical' cerebral dominance.     

A case of crossed aphasia in a dextral patient with polycythemia]

We report a 72-year-old right-handed man who was diagnosed as having crossed aphasia. He had polycythemia, hypertension and an old cerebral infarction in the right occipital lobe. He was admitted to our hospital because of muscle weakness in the left extremities at the age of 71. In the laboratory data, red blood cells(689 x 10(4)/microliter) and platelets(87.6 x 10(4)/microliter) were increased in number. Brain CT detected a right putaminal hematoma and an old infarct in the occipital lobe on the right. After admission, he developed non-fluent speech, and impairments of auditory comprehension, writing and naming due to the infarction in his right cerebral hemisphere including the middle cerebral artery distribution. The standard language test of aphasia(SLTA) revealed marked impairments in the language function, except for reading kana and kanji words. This writing was severely impaired compared with other language dysfunctions. Auditory comprehension, repetition and reading were impaired at the sentence level rather than at the kana word level. Furthermore, he suffered from left hemiparesis and left unilateral spatial neglect. We diagnosed his impairments of language function as crossed aphasia based on his right-handedness, CT findings and the results of SLTA. His language center was considered to be located in both cerebral hemispheres. Compared with typical findings in reported cases of crossed aphasia, the presence of both non-fluent speech and mutism were consistent with previous observations. However, the marked impairments of auditory comprehension, repetition and naming were different. Polycythemia and hypertension were considered to be the risk factors of cerebral infarction in our patient.     

Crossed aphasia: a PET follow up study of two cases.

Two cases of aphasia after right hemispheric stroke in right handed patients are described. The first patient had a severe mixed transcortical aphasia, apraxia and neglect after a lesion involving the right lenticular nucleus and periventricular white matter; aphasia was still present after three months. The second patient had a mild, transient fluent aphasia after a small right hemispheric periventricular lesion. Studies with [18F]FDG and positron emission tomography (PET) showed functional depression extending to the structurally unaffected left hemisphere in both patients in the acute stage. After three months, in the patient with persistent aphasia, metabolism was still reduced in the right hemisphere, with some recovery of hypometabolism on the left, while metabolic values had returned to normal in the patient with full language recovery. A close parallelism between glucose metabolism and clinical course in crossed aphasia is shown, as well as the presence of a functional involvement of the structurally unaffected left hemisphere in the acute stage.     

Two cases of crossed aphasia in dextrals.

Two cases of crossed aphasia in dextrals are reported, in one of which right hemisphere dominance was confirmed by an intracarotid amytal test. The possibility of a partial dissociation between oral and graphic expression is considered.     

Dissociation between personal and extrapersonal neglect in a crossed aphasia study

Abstract Several reports document crossed aphasia following a right cerebral infarct. However, few of them provide a detailed investigation of associated neuropsychological disorders. A personal neglect disorder with no difficulty in orienting attention in the contralesional space has not been frequently reported independently of lesion side for the language deficit. In most cases, the deficit is described in the acute period. We report the case of a patient who showed severe crossed aphasia several months after cerebral damage. In addition to his language deficit, he suffered from finger agnosia, acalculia, and right/left confusion. Although he was able to orient attention in the contralesional space, he had a persistent personal neglect disorder with severe difficulty in attending to his own body. Results suggest that right hemisphere language dominance does not preclude ipsilateral specialisation for other functions. Furthermore, the dissociation between the two spatial functions provides further confirmation that they are subserved by two independent systems.     

Crossed aphasia in a right-handed patient

A case of crossed aphasia in a right-handed patient provided evidence that cerebral dominance for speech may be located in the right hemisphere. Intravenous injection of amytal in the left carotid artery did not worsen the language disturbances. Comparison of this case with those reported shows that there is not a constant model with only one physiopathological mechanism for all cases of crossed aphasia in right-handed patients.     

Agrammatic primary progressive aphasia in two dextral patients with right hemispheric involvement

Agrammatic primary progressive aphasia (PPA-G) has been known to be associated with focal brain atrophy involving the left posterior frontal and anterior insular regions. However, aphasia can also rarely result from right hemispheric lesions in right-handed patients, so-called crossed aphasia in dextrals (CAD). We report two right-handed patients with PPA-G whose 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) showed hypometabolism predominantly in the right hemisphere, implicating “crossed PPA-G.”