"右片麻痺を伴った左手の失書"の1例

"Left Unilateral Agraphia with Right Hemiparesis" after Occulusion of the Left Middle Cerebral Artery

　左中大脳動脈領域に広範な病巣をもち，失語や失行を呈さず，失書を呈した右利きの脳梗塞患者を報告した。症例は56歳の右利き男性で，脳梗塞の発症1カ月後に右片麻痺のため当科を受診。神経学的には右同名半盲と右片麻痺，右半身の表在・深部覚鈍麻，右半側空間無視を認めた。失語症は認めず，発話面・理解面ともに正常であった。これに対し，書字は困難で，自分の名前や住所なども誤った。また，書き取りを施行した場合には，想起障害が多く，形態的に類似した文字への置換もみられた。CTでは左中大脳動脈領域に広範な低吸収域を認めた。右半側空間無視は3カ月後に消失したが失書は残存した。本症例の言語機能は左右半球で解離し，右半球に発話や理解，左半球に書字の機能が存在し，左半球損傷によって失書のみを呈したものと推察された。

This paper presented a case of a right-handed male who showed a right hemiplegia without apha-sia and apraxia. He lost the ability to write with the left hand. A 56-year-old right-handed man, who had a daughter of left-handedness, was sent to our hospital with a homonymous hemianopsia, facial weakness, spastic hemiparesis and sensory distur-bance in the right side. CT scan revealed an infarc-tion in the territory of the left middle cerebral artery. On a month after the onset, he was alert and oriented. His speech was normal and verbal compre-hension was intact. Although he neglected the right side of the page, he could read and comprehend it correctly. In contrast with his normal abilities to speak, comprehend, and read, difficulties in writing were prominent. Spontanous writing with the left hand was extremely poor, and he even had difficultywriting his own name. His dictation was also poor, but his writing improved with copying letters. Agra- phia had seen even after USN was recovered. Analysis of this case suggested the presence of thedomminance for speech, comprehension, and praxis in the intact right hemisphere, and writing center in the damaged left hemisphere.