不同部位及损害与失写症关系的研究

目的：系统了解不同部位脑损害致汉失写症的特点。方法：采用ABC法和CAB法测定试口语和书写能力,统计言语障碍类型,计算各项书写得分和失写指数,比较大脑各部位之间的差异。结果：56例患者中左侧半球损害41例,其中失语30例,失写32例,后者中纯失写1例,失读并失写1例;右侧半球损害15例,其中失语合并失写3例,两侧半球间失语失写率有显著性差异（P＜0．01）。左侧半球不同部位之间不同书写项得分无显著性差异（P＞0．01）结论：不同部位脑损害引起的失写有各自的特点。但相互之间部分性质存在交叉重叠现象,左侧半球不同部位之间书写项得分没有差别。     

大脑双侧半球病变所致汉语失写的差异

目的探讨大脑双侧半球所致汉语失写症的差异以及神经心理学机制。方法采用汉语失语检查法(ABC)及汉语失写检查法(CAB)测试大脑双侧半球损害患者的口语和书写能力,统计失语类型及失写类型。结果100例患者中,左侧皮层损害Broca失语14例,命名性失语11例,左侧皮层下损害主要是基底节性失语19例;右侧皮层损害纯词哑1例和纯失读1例,右侧皮层下损害全部是基底节性失语7例;左侧皮层损害失语性失写57例,惰性失写12例;左侧皮层下损害语言性失写26例,惰性失写6例;右侧皮层损害全部是语言性失写2例;右侧皮层下损害语言性失写5例,视空间失写1例;两半球损害致失语、失写发生率之间的差异是显著的(P<0.05),左半球损害后失语和失写的发生率均较右半球损害高。结论左右半球协同合作完成汉字语言信息的完整处理。     

脑血管病失写症患者病变部位的研究

本研究采用脑ＣＴ图象标准化处理的方法，对脑血管病失写症患者书写能力和神经影像学检查结果进行综合分析。结果：１９例失写病人表现出失语性、惰性、视空间性、失用性、镜像及完全性６种不同的失写性质，每个病人可表现出１～３种。推测某些神经结构在书写行为执行过程中的作用：（１）大脑半球的许多区域，尤其是左半球的大部分，均与失语性失写有关。（２）惰性失写的病变部位均涉及到左侧额叶后部。（３）视空间失写是空间性障碍的一种特殊类型，后者与右半球主管的空间性视觉记忆、选择指向能力的损害有关。     

基底节病变时语言障碍的书写特点

目的通过对基底节病变时患者语言障碍及汉字书写特点的研究,探讨其可能的神经心理学机制。方法对103例基底神经节病变患者采用汉语失语检查法(ABC法)和汉语失写检查法(CAB法),从听、说、读、写4个方面全面评估患者的语言能力,筛选出语言障碍者40例,确定其书写障碍的类型、严重程度及其与其他语言障碍之间的相关性。结果除书面理解和口语表达间差异无显著性意义外,其余口语和书面语语言障碍间的差异均有显著性意义。在口语表达与书面语表达各项之间均存在正相关关系,在书面语理解与书面语表达之间均存在正相关关系,基底节病变书写障碍程度左侧重于右侧,双侧最轻。结论在基底神经节病变的口语和书面语损害之间,既相互联系又各具特点,基底神经节参与言语和书写过程的神经心理学机制是有所差异的。     

左半球卒中所致的单纯失写症临床分析

目的:探讨左半球病变时汉语单纯失写症的发生率、语言学特点及病变部位。方法:对经头颅CT确诊的右利手左大脑半球卒中无口语表达及听理解障碍的患者采用《汉语失语症检查法》进行检查,同时检查视空间能力。结果:21例患者中有6例出现单纯失写症,占28.6％。6例失写症患者均无视空间障碍。5例因右侧瘫痪,只用左手书写,1例患者因瘫痪轻微左右手均进行了书写检查。书写障碍的语言学特点包括构字障碍、象形写字、语词性失写和镜像书写。病变部位包括左侧半球的丘脑、底节、顶叶、额顶叶和侧脑室旁。结论:①单纯失写症并非罕见,而是一常见的综合征;②许多病变部位均可引起单纯失写症,提示了失写症发生机制的复杂性。     

右侧卒中后心率变异性的降低

本文选择一组单侧卒中病人,检测其深呼吸时的心率变异及倾斜与等长抓握试验时血压与心率的改变,探讨左或右侧脑损害对于这些反射是否会引起不同的影响。作者选择以往健康的单侧卒中病人23例(年龄59±12岁)与一组健康人(n=21,年龄61±12岁)及有一次TIA发作史但以往健康的病人(n=11,年龄59±16岁)作比较。其中13例病人(年龄62±10岁)为右侧脑损害,10例(年龄55±15岁)为左侧脑损害;有14例为半球损害,8例为脑干损害。 结果发现,深呼吸时心率RR间期的差异在大脑右侧损害时较左侧显著减小,左与右侧半球损害亦存在这种差异,但右半球与右脑干损害则无此差异。在3分钟     

Gerstmann综合征临床与神经心理学研究

目的研究Gerstmann综合征(GS)的临床与神经心理学特点。方法采用汉语失语症成套测评(ABC)、书写及视空间检查,对259例经CT或MRI检查确诊为脑卒中或脑损伤的患者进行评价。结果 (1)259例患者中有19例患有Gerstmann综合征(GS),其中9例有GS四主征、10例有GS的核心症状、命名性失语(AA)5例、经皮质运动性失语(TCM)2例、经皮质感觉性失语(TCS)4例、Wernicke失语3例、构音障碍2例、无失语5例;(2)病变部位:左顶枕、左侧颞顶、左侧颞顶枕、左侧额顶枕和左侧基底节共17例,右侧基底节、顶叶损害2例。结论 (1)Gerstmann综合征不是一个独立的综合征;(2)其病变部位不仅仅限于优势半球顶叶。     

脑外伤患者认知障碍的特点及康复疗效分析

目的探讨脑外伤患者认知障碍的临床特点及综合康复治疗效果。方法选取2013-08—2015-08我院收治的60例脑外伤认知障碍患者,回顾性分析其临床资料,观察患者的临床特点,均接受颅脑损伤常规治疗,同时联合高压氧、康复疗法进行治疗,采用认知评定测验量表(LOT-CA)评价患者治疗前后的认知障碍程度。结果 60例患者的临床特点主要包括应变及推理能力下降、注意力下降、记忆力下降、感觉能力下降、失语,分别占56.7%、46.7%、70.0%、31.7%、66.7%。双半球、右半球、左半球损伤部位患者治疗后的思维动作、视觉运动、定向、知觉等LOT-CA总分均高于治疗前,差异有统计学意义(P0.05);其中右侧半球脑损伤患者治疗后的LOT-CA总分高于左侧半球脑受损、双侧半球脑损伤患者,差异有统计学意义(P0.05)。结论不同损伤部位脑外伤认知障碍患者的临床特点不同,采用综合康复治疗的疗效确切,改善患者认知功能。     

脑型肝豆状核变性患者中文书写特点

目的 通过观1察脑型肝豆状核变性患者中文书写特点,探讨基底神经节病变与中文书写的关系.方法 采用汉语失写检查法对35例脑型肝豆状核变性患者进行中文书写检查.结果 ①22例患者出现书写障碍(62.9%),以看图书写成绩最差,其他依次为主动书写、听写、自动书写和抄写.②14例患者出现语言性书写障碍(40%),11例患者出现运动性书写障碍(31.4%).其中存在多种书写障碍类型并存的现象.③在语言性书写障碍的患者中:构字障碍12例,字词错写4例,语法错误2例.④在运动性书写障碍的患者中:小写症5例,震颤性书写4例,重复性书写2例.结论 书写障碍是脑型肝豆状核变性的常见症状,以构字障碍最多见,提示基底神经节参与汉字书写过程.     

不同部位、范围急性脑血管病患者紧奏—血管紧张素系统的变化

目的研究肾素(RA)、血管紧张素Ⅱ(AⅡ)、醛固酮(ALD)在不同部位、范围的急性脑血管病(ACVD)患者中的含量及其作用.方法采用放射免疫法测定236例ACVD患者及63名正常对照者血浆RA、AⅡ、ALD含量.结果不同部位ACVD患者血浆RA、AⅡ、ALD含量较正常对照组显著升高(P<0.01).不同部位脑出血时,血浆RA、AⅡ、ALD含量比较呈丘脑>基底节>脑叶,有显著性差异(P<0.01).不同部位急性脑梗死时,以大脑中动脉系梗死RA、AⅡ、ALD含量最高,与丘脑梗死组、基底节梗死组及脑叶梗死组比较有显著性差异(P<0.01～0.05),而后3组之间RA、AⅡ、ALD含量比较无显著性差异(P>0.05).ACVD不同病损范围,血浆RA、AⅡ、ALD含量随着脑损伤范围增大而增高.结论肾素-血管紧张素-醛固酮系统(RAS)改变与不同部位、范围ACVD密切相关,测定血浆RA、AⅡ、ALD含量, 对临床监测ACVD患者病情,判断预后及提高治疗效果有积极的意义.     

Pure agraphia with topographical disorientation caused by right hemisphere lesion

A 69-year-old, right-handed, Japanese male patient presented with pure agraphia with topographical disorientation after hemorrhage in the right parietal lobe. Upon developing cerebral hemorrhage, he was referred to our hospital for close examination of agraphia. There was no paresis or clumsiness in his extremities. His speech was fluent and well-articulated. Neither aphasia nor reading impairments was found, although there was a clear writing impairment with effort and hesitation. His writing of both kanji and kana letters contained additional, absent or deformed strokes or parts. No hemianopia, prosopagnosia, constructional disturbances and dressing apraxia were found. He could recognize familiar buildings or landscapes, but often lost his way around well-known areas. MR images revealed subcortical lesions of precuneus, superior and inferior parietal lobules in the right hemisphere, around the posterior horn of the lateral ventricle. He revealed pure agraphia and topographical disorientation after the right brain haemorrhage, without dementia or personality change. These findings indicate that the right parietal lobe participates in the kinesthetic movements of writing. Some authers have been documented cases of aphasic agraphia or alexia with agraphia caused by right hemisphere damage in dextrals, but pure agraphia caused by the lesion in the right hemisphere is very rare.     

Crossed Aphasia: One Or More Syndromes?

Seven strongly right-handed patients developed aphasia following a right hemisphere vascular lesion documented by computerized tomography. One patient had a severe unilateral neglect, indication of its presence were evident in three and absent in three patients. The Token Test scores were significantly higher than in matched controls. Two patients had Broca aphasia, four had Wernicke aphasia and one had agraphia. The correlation between type of aphasia and locus of lesion was not much different from that normally found in standard left hemisphere brain damaged aphasics.     

汉语失写检查法的制定和标准化

目的全面、系统、准确地评定汉语失写症患者的书写能力。方法设计了一套汉语失写检查法，包括自动书写、抄写、听写、看图书写、主动书写及相关能力的检查六个部分，并可通过各部分的量表分计算失写指数。结果经１０１例正常受试者的标准化研究，发现重测信度和效标效度良好，文化程度是影响书写成绩的重要因素，按文化程度划分了失写指数的正常分界值。结论该检查法的编制符合失写检查和心理测验标准化的基本要求，为失写症的定量、定性分析提供了一个标准化的检查手段。     

Right hand agraphia and left hand apraxia following callosal damage in a right-hander

A right-handed Japanese man showed agraphia more marked with the right hand, apraxia confined to the left hand, and right ear extinction on dichotic listening, following damage to the anterior two-thirds of the corpus callosum, the rostral and lower parts of the right medial frontal lobe and a small portion of the left medial frontal lobe. The symptoms were attributed to hemispheric disconnection, on the assumption that the right hemisphere was dominant for language and the left for limb praxis. This case provides good evidence for dissociated lateralization of language and limb praxis in some right-handed individuals. The study of writing performance suggested the following hypotheses: (1) motor engrams for limb praxis and writing may be dissociated, and (2) motor engrams for writing Kana (phonogram) and Kanji (ideogram) letters are represented on both hemispheres, although the hemisphere nondominant for language seems unable to combine graphemes into a correct meaningful sequence.     

Pure "aphasic" agraphia due to damage of the left superior parietal lobule

A case of pure agraphia, due to an ischaemic lesion of the left superior parietal lobule, is reported. The neuropsychological analysis of writing performances suggests an aphasic nature of this patient's pure agraphia. The authors discuss the role played by diffuse and/or localized brain lesions in writing function, emphasizing that the left superior parietal lobule in man may be crucial for the sensorimotor linguistic integration needed for writing.     

Left superior parietal cortex involvement in writing: integrating fMRI with lesion evidence

Writing is a uniquely human skill that we utilize nearly everyday. Lesion studies in patients with Gerstmann's syndrome have pointed to the parietal cortex as being critical for writing. Very little information is, however, available about the precise anatomical location of brain regions subserving writing in normal healthy individuals. In this study, we used functional magnetic resonance imaging (fMRI) to investigate parietal lobe function during writing to dictation. Significant clusters of activation were observed in left superior parietal lobe (SPL) and the dorsal aspects of the inferior parietal cortex (IPC) bordering the SPL. Localized clusters of activation were also observed in the left premotor cortex, sensorimotor cortex and supplementary motor area. No activation cluster was observed in the right hemisphere. These results clearly indicate that writing appears to be primarily organized in the language-dominant hemisphere. Further analysis revealed that within the parietal cortex, activation was significantly greater in the left SPL, compared to left IPC. Together with lesion studies, findings from the present study provide further evidence for the essential role of the left SPL in writing. Deficits to the precise left hemisphere parietal cortex regions identified in the present study may specifically underlie disorders of writing observed in Gerstmann's syndrome and apractic agraphia.     

Pure “aphasic” agraphia due to damage of the left superior parietal lobule

A case of pure agraphia, due to an ischaemic lesion of the left superior parietal lobule, is reported. The neuropsychological analysis of writing performances suggests an aphasic nature of this patient's pure agraphia. The authors discuss the role played by diffuse and/or localized brain lesions in writing function, emphasizing that the left superior parietal lobule in man may be crucial for the sensorimotor linguistic integration needed for writing.     

Acquisition of a motor skill after left-hemisphere damage

Specialization of function in the left hemisphere of man, as compared with the right, was studied with special reference to the nature of the impairments seen after left-hemisphere damage. Patients with unilateral lesions of the left or the right hemisphere were compared in the acquisition and subsequent performance of a manual skill requiring several hand movements. Patients with left-hemisphere damage were further subdivided into aphasic and non-aphasic groups. Patients with left-hemisphere damage were further subdivided into aphasic and non-aphasic groups. Patients with left-hemisphere damage, whether aphasic or not, were impaired in the acquisition of the task, relative to patients with right hemisphere damage, although aphasics were most severely impaired. Analysis of the errors made during acquisition indicated that perseverative errors and unique errors (unrelated movements) differentiated the left and right groups, but that sequencing errors did not. It was concluded that a major function of the left hemisphere is the control of changes in limb or articulatory posture, and that its complex verbal and praxic functions are derived from such control.     

Auditory sequencing and left cerebral dominance for language

The Sequencing Test, which evaluates the capacity to maintain and utilize the sequential aspects of a verbal acoustic input, has demonstrated significant differences in this capacity in brain damaged and normal subjects: left brain damaged worse than right brain damaged worse than controls. Subjects with left brain damage without aphasia performed as well as subjects with right brain damage. Of the 29 aphasics given this test 27 had a significantly deficient performance by comparison with the non-aphasic brain-damaged subjects. Thus, although disturbances in “auditory sequencing” ability may be found following brain damage in general, they are significantly more prominent in aphasic subjects. It is proposed that the left cerebral hemisphere is dominant for language in right-handed individuals, at least in part, because of its predominant capacity to manipulate the sequential aspects of verbal acoustic inputs.