基底神经节区脑损害与汉语失写症关系的研究

Association of basal ganglia damage with Chinese agraphia

目的研究基底神经节损害所致汉语失写症的特点。方法采用汉语失语检查法(ABC)及汉语失写检查法(CAB)测试基底神经节损害患者的口语和书写能力,统计言语障碍类型,计算各项书写得分和失写指数。结果38例患者中,左侧基底神经节损害21例,其中失语18例,失写18例;右侧损害14例,其中失语1例,失写4例,左右两侧失语失写率有显著性差异(P<0.01);双侧损害3例,均伴失语,失写2例。汉语书写障碍类型主要为构字障碍、字词错写和语句篇章层级书写障碍。结论基底神经节损害可导致汉语失写症,其失写语言机制可能有低灌注机制、整合中枢、环路受损、字形在脑内结构的记忆提取受损等。

Objective To study the clinical features of Chinese agraphia caused by basal ganglia damage. Methods The Chinese speaking and writing abilities of 38 patients with basal ganglia damage were evaluated with aphasia battery and agraphia battery of Chinese, respectively, and the agraphia quotient (AgQ) and the scores for writing abilities calculated. Results Of the 38 patients, 21 had left basal ganglia injury, which was responsible for aphasia in 18 and agraphia also in 18 patients. Another 14 patients had right basal ganglia injury and caused aphasia in 1 case and agraphia in 4. The rest 3 patients had injuries of the basal ganglia on both sides that resulted in aphasia in all and agraphia in 2 of them. Significant diferrence was noted in the incidence of agraphia between patients with left and those with right basal ganglia injuries, characterized by difficulty in building the Chinese characters, mistakes in writing the characters and disability of writing at the level of sentences and paragraphs of Chinese. Conclusion Basal ganglia damage may result in Chinese agraphia, due to, hypothetically, hypoperfusion, dysfunction of integration center, circuit damage and impaired function in extracting the graphical features of the Chinese characters from memory.