2019 Volume 39 Issue 4 Pages 394-403
We report a patient with non-fluent spontaneous speech after multiple cerebral infarction of white matter. A 69-year-old, right-handed female showed non-fluent spontaneous speech with restatements, repeats of the same word, and interjections. Brain MRI showed multiple infarcts in the cerebral white matter and stenosis of the proximal portion of the left middle cerebral artery.
In order to analyze the mechanism of her speech disorder, we evaluated her abilities regarding word finding and sentence composition, and cognitive functions such as the frontal lobe function, attention, and a process of thinking, which can influence speech.
Word finding during spontaneous speech was markedly impaired, but visual naming, auditory naming, and word finding were only mildly impaired. On the other hand, sentence composition was moderately disturbed, although the grammatical ability was not apparently associated with expression. Moreover, frontal lobe symptoms such as fixed thinking and poor flexibility could also be associated with non-fluent spontaneous speech.
The lesions of cerebral infarction were circumscribed within the cerebral white matter, whereas the areas of low perfusion were broadly disseminated in left frontal, parietal, and temporal lobes. Her non-fluent spontaneous speech might be caused by broad ischemic cerebral lesions or disconnection between cerebral cortical areas affected by infarction in the cerebral white matter.
