皮质下失语的研究与进展

Research and progression of subcortical aphasia

目的:皮质下失语一直是神经科医师争论的焦点。近年来,随着功能影像技术的飞速发展,人们对皮质下失语的病因、临床表现及发病机制都有了新的认识,但尚未达成共识。资料来源:应用计算机检索Medline1980-01/2005-04期间与皮质下失语相关文章,检索词“subcorticalaphasia”、“thalamicaphasia”、“gangliaaphasia”,并限定文章语言种类为English。资料选择:对资料进行初审,选取双盲随机对照的临床研究,筛除明显不随机或没有对照组的临床研究及重复性研究。资料提炼:共收集到88篇相关文献,排除的27篇中,有19篇为重复性研究,8篇为个案报道。纳入61篇,其中关于皮质下失语的病因及分类25篇、临床表现24篇、发病机制及预后22篇。资料综合:皮质下失语的病因有缺血病变、脑出血及其他3类。按部位不同包括内囊纹状体区(基底节)失语、丘脑失语、脑室旁白质失语及小脑失语4类,而临床表现也因部位的不同而有所差异。皮质下失语的机制为:皮质下损害的直接效应、语言的实质皮质结构断开、损害了公式化的皮质语言输出中的语言“释放”片断、、神经机能失联系、皮质功能障碍、皮质执行功能障碍综合症。但发病机制仍然存在很多的争议。结论:皮质下失语临床表现多样,发病机制复杂不祥,需要进一步研究。

OBJECTIVE： Subcortical aphasia is always debated by neurologist. Recent years, new suggestion on etiological factor, clinical manifestation, and mechanism about subcortical aphaisa is found with the fast development of function imaging technique. However, does not gain agreement. DATA SOURCES： We searched the Medline for related articles on subcortical aphasia published between January 1980 and April 2005 with the key words ＂subcortical aphasia＂,＂thalamic aphasia＂,＂ganglia aphasia＂ in English. STUDY SELECTION： After primary examination, the randomized and double-blind controlled trials were selected, excluding the obvious non- randomized or non-controlled and repetitive clinical studies. DATA EXTRACTION： Totally 88 relevant literatures were collected. Of the 27 excluded literatures, 19 were repetitive studies and 8 were case reports. Of the 61 included articles, 25 articles were on etiological factor and classification of subcortical aphasia, and 24 for clinical manifestation, and 22 for mechanism and prognosis of subcortial aphasia. DATA SYNTHESIS： Etiological factors of subcortical aphasia contained ischemic lesion, cerebral hemorrhage and others. Subcortical aphasia included striatocapsule （basal ganglia） aphasia, thalamic aphasia, the white matter of periventricular aphasia and cerebellar aphasia, according to the site of damage. Clinical manifestations were different based on the site of damage. Subcortical aphasia could explain by： a direct effect of subcortical lesion, disconnection of cortical structures that were essential for language, impaired ＂release＂ of language segments formulated in the cortes into output, diaschisis, cortical dysfunction, and cortical dysexecution syndrome. But there were a lot of discussions about the mechanism of subcortical aphasia. CONCLUSION： Clinical manifestation of subcortical aphasia is all sorts or varieties; mechanism of subcortical aphasia is complicated, which needs to be researched further.