皮質下出血にみられた失語症外科的治療の有用性—標準失語症検査法（SLTA）による手術前後の評価

APHASIA ASSOCIATED WITH SUBCORTICAL HEMATOMA

I．はじめに

　失語，失行，失認などのいわゆる大脳巣症状は，脳における各種の病変に観察される。脳出血においても，これら巣症状はしばしば経験するところであり，その対策に苦慮することが多い。今回著者らは，失語症状をもつて発症した皮質下出血5例を経験したが，うち4例に血腫除去術を行ない，術後の失語症検査で著明な症状の改善を認めた。皮質下出血は早期に診断をくだし，その適応を考慮した上で外科的治療を行なえば，脱落症状を残すことはすくない。そこで本論文では，特に言語機能改善の面から外科的治療の意義につき論じる。手術前後の言語機能の評価にあたつては，最近完成された標準失語症検査法（Standard Language Test of Aphasia （SLTA））^1）を用いたので，この検査法の意義についても述べる。

In this paper we analysed 5 cases of subcortical hematoma. This series comprises 3 males and 2 females with ages from 18 to 68. All of them showed sudden onset; their initial symptoms were speech disturbance, headache, nausea with vomiting, hemiparesis and consciousness disturbance. Because of such clinical symptoms they were initially treated in each hospital with the diagnosis of sub-arachnoid hemorrhage, cerebral infarction or brain tumor of apoplectic type, etc.

When admitted to our hospital, the most striking symptom of them was aphasia; 1 patient of con-duction aphasia, 1 patient of predominantly ex-pressive aphasia and 3 patients of receptive and expressive aphasia. Neuroradiological examinations such as cerebral angiography and computerized transaxial tomography revealed subcortical hematoma; one in the left frontotemporal region, one in the right temporoparietal region (right handed crossed aphasia) and three in the left posteriotemporal region. Evacuation of hematoma was performed in 4 patients 2 to 23 days after admission to our hospital. In 3 of them, marked recovery from aphasia as well as motor disturbance was observed soon after operation. The other patient, who was not operated upon because of heart disease and sent to the speech and physical rehabilitation hospital, showed little progress in speech function even 7 months after onset. It is certain that speech rehabilitation by the specialist is very helpful for aphasics but there are some cases which must be treated surgically before speech rehabilitation is considered.

Recently we have been using the Standard Language Test of Aphasia (SLTA) for examining aphasics. This comprehensive test battery was constructed by Japan Aphasia Study Group in 1975, and is very practical for clinicians not only to analyse the aphasic symptoms but also to evaluate the effect of therapy of aphasia including surgical treatment.