感覚失語の型をとる右利き交叉性失語症の1例

Crossed Aphasia in a Dextral Patient : A Case of Sensory Aphasia due to a Right Hemispheric Lesion

　感覚失語の型をとる右利き交叉性失語症の1例を報告した。症例は，発症時61歳の右利き男性で，右側頭—頭頂葉の脳出血術後より自発語のジャルゴン，優位半球性の構成失行，観念失行，着衣失行が出現しだし，発症半年後の標準失語症検査でも，言語理解の障害，流暢で錯語の多い発語，復習障害，錯書など，感覚失語を呈していた。頭部CT, MRI, IMP-SPECTでは，右側頭—頭頂葉，角回に病変が存在し，この原因病巣と思われた。本例と同様の症例にはPuelらの1例とHabibらの1例があり，これら3例は，自発語のジャルゴン，錯書，失行を呈しており，その原因病巣は，Wernicke領域を含む右大脳半球の深部にまで広がっていた。本例において，その発症機序は，右半球が優位半球であるためであろうと考察した。

An extremely rare case of sensory aphasia due to a right hemispheric lesion in a 61-year-old, right-handed male is reported. He manifested jargon aphasia, constructional apraxia and ideational apraxia after an operation for right temporo-pari-etal cerebral hemorrhage. Standard language test of aphasia (SLTA) administered 6 months after the onset revealed disturbance of verbal comprehension and repetition, fluent jargon with many paraphasias and paragraphias. The brain CT, MRI and IMP-SPECT disclosed right temporo-parietal and angu-lar lesions. There are two other reported cases of right posterior lesion (fuels et al. 1982, Habibs et al. 1983) accompanied by symptoms similar to those in this case, e.g., jargon aphasia, paragraphia and apraxia, and in these cases as well the right deep hemispheric lesion encompassed Wernicke's area.

It is suggested that the right and left brain func-tions are reversed in this patient, because the symp-toms of the dominant hemisphere such as sensory aphasia, constructional apraxia, and ideational apraxia were associated with the lesion of the right hemisphere.