脑梗死后失语症类型与病变部位的关系

背景病变部位对失语症的发生及失语症的类型起着决定性的作用,但却不能很好地解释临床上的某些现象,失语症类型与病变部位之间有何关系?目的探讨病变部位对失语症类型的作用,并分析两者之间的关系.设计病例观察.单位牡丹江医学院附属红旗医院神经内科.对象纳入牡丹江医学院附属红旗医院神经内科2003-08/2004-06住院的急性脑梗死后失语症患者98例.男63例,女35例;平均年龄(68±4.56)岁;病程2～4周.方法应用北京医科大学第一医院神经内科的汉语失语成套测验中的利手评定进行利手判定,西部失语成套测验进行失语症的分类,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及CT和MRI检查.主要观察指标脑梗死患者失语症的类型和病变部位.结果按实际处理分析,98例均进入结果分析.①利手判定98例失语症患者均为右利手.②失语症的类型Broca失语21例,Wernicke失语15例,传导性失语2例;经皮质运动性失语8例,经皮质感觉性失语7例,经皮质混合性失语12例,完全性失语23例,命名性失语10例.③病变部位位于经典的语言中枢的有56例,38例为非语言中枢受累;波士顿诊断性失语严重程度分级标准评定结果为0级28例,1级30例,2级14例,3级16例,4级10例,其中0级、1级病变部位多为语言中枢.结论失语症的类型与经典的语言中枢并不完全相符,非语言中枢病变也可引起失语,病变部位位于语言中枢的失语严重程度较大.

Relationship between the site of cerebral infarction induce-aphasia and aphasia types

BACKGROUND: The location of cerebral infarction determines the onset and type of aphasia, but this relationship may fail to explain some clinical findings in these patients. The exact relationship between the type of aphasia and the locations remains to be fully unclear.OBJECTIVE: To investigate the relationship between the location of cerebral infarction and the type of aphasia.DESIGN: Case-controlled study.SETTING: Department of Neurology, Hongqi Hospital Affiliated to Mudanjiang Medical University.PARTICIPANTS: Totally 98 patients admitted in the Department of Neurology, Hongqi Hospital Affiliated to Mudanjiang Medical University for aphasia secondly stroke between August 2003 and June 2004 were enrolled in this study, including 63 male and 35 female patients with the mean age of (68±4.56) years and disease course varying from 2-4 weeks.METHODS: Handedness evaluation was performed using the subtest of handedness in the Chinese aphasia test battery designed by the Department of Neurology, First Hospital of Beijing Medical University. Aphasia was classified on the basis of Western Aphasia Battery and evaluated for severity according to the grading criteria of Boston Diagnostic Aphasia Examination. The patients received also CT and MRI examinations.MAIN OUTCOME MEASURES: Aphasia type and lesion site in pa-tients with cerebral infarction.RESULTS: Analysis was made according to the real data, all 98 cases entered into the result analysis. All the 98 aphasic patients were right-handed,with 21 patients having Broca's aphasia, 15 Wernicke's aphasia, 2 conduction aphasia, 8 transcortical motor aphasia, 7 transcortical sensory aphasia,12 transcortical mixed aphasia, 23 complete aphasia and 10 anomic aphasia. The lesion involved the classic language function area in 56 cases, and did not affect the language functional area in 38 cases. According to the grading criteria of Boston Diagnostic Aphasia Examination, 28 patients were in grade 0, 30 in grade 1, 14 in grade 2, 16 in grade 3 and 10 in grade 4.Most of the patients in grades 0 and 1 had lesions involving the language functional area.CONCLUSION: Aphasia type does not totally conform to the classic speech center lesions, and involvement of the non-speech centers may also cause aphasia, but speech center lesions lead to more serious aphasia.