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Brain and Nerve No to Shinkei Volume 26, Issue 4 （April 1974）

Brain and Nerve 脳と神経 26巻4号（1974年4月発行）

Japanese English

原著

左Subthalamotomy後に生じた"純粋"失書 "PURE" AGRAPHIA AFTER THE LEFT SUBTHALAMOTOMY 杉下守弘 ¹ , 楢林博太郎 ² Morihiro Sugishita ¹ , Hirotaro Narabayashi ² ¹東京大学医学部脳研神経内科 ²順天堂大学医学部脳神経科 ¹Department of Neurology, Institute of Brdin Research, School of Medicine, University, of Tokyo ²Department of Neurology, School of Medicine, Juntendo University pp.489-496

発行日 1974年4月1日 Published Date 1974/4/1

DOI https://doi.org/10.11477/mf.1406203542

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Abstract 文献概要
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I．はじめに

　他の言語機能に障害がなく，書くことだけができない，しかも書くことができないのは麻痺や失行によるのではない症例，すなわち純粋失書は大変稀である。症例報告も少く，その存在について疑問さえ生じていたが，最近，Dubois, Hécaen et Marcie^4）は6例の純粋失書を報告して純粋失書の存在を主張した。著者のうちの1人は，左CM-thalamotomy後にほぼ純粋失書と考えられる症例を観察し，損傷部位として，右第2前頭回脚部の皮質および皮質下白質の損傷を想定するとともに，左視床後内側部の腹側域（特に左CMの下部）の損傷の影響を考えた（杉下・他^14））。われわれは新たにもう一例のほぼ純粋失書と考えられる症例を左subthalamotomy後に観察したので，これを報告する。その失書症状の究明を試みるとともに，先に報告した症例と比較検討し，また純粋失書の損傷部位に関して若干の考察を行なつた。

Another case with "pure" agraphia after stereo-encephalotomy was studied, compairing with the previously reported "pure" agraphia case. (Japan J. Cli. Neurol. 10 : 568-574 1973)

A 57-year-old right handed male underwent the left subthalamotomy for his right hand tremor.

He had severe agraphia, slight consciousness disturbance, slight memory disturbance, minimal naming difficulty and minimal oral camprehension disturbance after the operation. He still showed severe agraphia about one and a half month after the operation, although the other disturbances gradually cleared up. At that time, spontaneous speech, naming and repetition were well preserved. Oral comprehension, reading comprehension, read-ing aloud and copying were not mpaired. Also, agnosia and apraxia were not present. His agra-phic responses were mostly composed of paragra-phias (51%) and no responses (30%), but showed sometimes perseverations (13%). These data showed that his agraphia was mainly due to the disorder in the selection (retrieval) of graphemes.

Outstanding manifestations of the case as com-pared with the previously reported one are as follows:

1) His "pure" agraphia was not transient, as it is still present on 124 th day after the operation.

2) This case showed no constuctional apraxra.

The second left subthalamotomy was done for his recurred tremor on 81 st day after the first operation, but it didn't influence his agraphia. The presumed site of the lesion was lateral to the one of the first operation.

The presumed site of the lesion common to two "pure" agraphia cases is the subthalamic area under the left centre median (CM). It was sug-gested the manifestation of "pure" agraphia might be related to the lesion of the subthalamic area under the left CM and probably to the surrounding area including the inferior part of the left CM.