Abstract
We report a case of aphemia who suffered from a cerebral infarction in the right frontal opercular region. The patient was a 61-years-old right handed male. His mother and brother were left handed. He suddenly noticed difficulty in speaking when he had been in a hospital due to acute myocardial infarction. On admission to our hospital he was alert. There was slight left hemiparesis and oral facial apraxia. He had no spontaneous speech, making a conversation in writing because of severe dysarthrophonia. He had normal comprehension to written and spoken language. He had no signs of aphasia, pseudobulbar palsy, or unilateral spatial neglect. An Xray CT and a magnetic resonance imaging (MRI) revealed a lesion due to cerebral infarction in the right middle and inferior frontal cortices. A single photon emission computed tomography (SPECT) using 123I-iodoamphetamine disclosed severe decrease of cerebral blood flow in the right anterior opercular region. An MRI angiography showed no steno-occlusive lesion in the main trunks of right middle cerebral artery. An echocardiography revealed mural thrombi in the left ventricle. The patient was diagnosed as having an embolic infarction in the right middle cerebral artery branch territory. After admission, he showed gradual improvement in dysarthrophonia. Intentional speech was more difficult for him than automatic and emotional speech. Seven months after the onset of stroke, mild slowness of speech and dysprosody persisted as only deficits. In this case, dysarthrophonia with sparing of language function was regarded as aphemia, that was the anterior opercular syndrome in the right frontal opercular lesion in a dextral. The patient might have predominant language function on the right hemisphere with the family history of left handedness. It is suspected that the middle and inferior fontal cortices on the dominant hemisphere for the language function play an important role on articulation and phonation.
