表象障害による左半側空間無視を呈した脳梗塞の1例

A Case of Representational Dysgraphia and Object Representational Disorder with Unilateral Spatial Neglect

48歳女性，左利き。右側の大脳基底核部，傍側脳室体部深部白質，側頭後頭葉から頭頂後頭葉接合部に梗塞巣を認めた。本症例の特徴は，漢字の書取りでは左側に位置する偏の想起困難を認めた。自発画では物体の左側が欠落した絵を描いた。物体は，立脚地点を反対側に変えてイメージして描いてもらうと最初に想起した絵の鏡像を描き，次に右側を描いた。しかし，全体像を構成させることはできなかった。一方，写字や絵の模写，家の見取図では左側の欠落は生じなかった。本症例の病態は文字と物体のイメージ障害であり，左半側の表象性書字障害と物体の表象障害と考えた。

Abstract

We describe the case of a 48-year-old left-handed woman with unilateral neglect from a brain infarction in the area of the right basal ganglia and temporo-parieto-occipital lobe. When a Kanji character was dictated to her, she wrote only the right side (tukuri) of the character. When copying a picture from the visual image of a left-right asymmetrical object, such as the side view of the dog, she drew the tail and a hind leg immediately but was unable to draw a picture of the dog from the left side. We asked her to imagine going around to the opposite side of the imaginary dog and to draw it from that perspective. She easily drew the left side first, resulting in a left-right inverted picture of what she had previously drawn. She then tried to slowly visualize the missing part of her imagery, and was able to draw only the right tip of the missing part. She could not compose a complete picture of the dog. These findings suggested that the impairment was in the imaging of the left side of a character or object and that this was a case of representational dysgraphia and object representational disorder with unilateral spatial neglect.

(Received May 2, 2014; Accepted September 24, 2014; Published March 1, 2015)