左半球卒中所致的单纯失写症临床分析

Agraphia without aphasia due to left cerebral hemispheric stroke in dextrals

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。

Objective;To investigate the occurrence, neurolinguistic features and responsible focus for agraphia without a-phasia in right handed patients. Methods; Twenty-one non-aphasic patients with left hemispheric stroke were examined with Chinese Aphasia Examination Scale and asked to draw a human face, a clock and house for assessing their visuospatial ability. Results ;Six out of 21 patients showed pure agraphia, accounting for 28. 6% . All 6 patients had no visuospatial impairment. Five patients with agraphia wrote using their left hands and one using both his hands when examined. The linguistic features of agraphia include construction disorder of characters, pictographic writing, lexical agraphia and mirror writing. The responsible foci for agraphia were respectively located at left thalamus, parietal lobe, basal ganglion, parieto-frontal lobe and white matter surrounding lateral ventricle. Conclusions; ①Pure agraphia is arather common than rare syndrome. ②That various sites of lesions led to a-graphia is suggestive of the complexity of agraphic neuropathogenesis and neurolinguistic mechanism.