A Case of Crossed Aphasia with Apraxia of Speech and Agrammatism due to Right Hemispheric Infarction Caused by Moyamoya Disease

Abstract

  We reported a case of right hemispheric cerebral infarction due to adult moyamoya disease, which presented with crossed aphasia and visuospatial impairment. The language disorder in this case consisted of two components : 1) apraxia of speech (AOS) , whose main symptom is prosody disorder, and 2) agrammatism, which consists of particle omissions and substitutions and difficulty understanding syntax. We compared our case with previously reported cases of AOS and agrammatism due to right hemispheric lesions in a right-handed patient. Although there were no major differences in the symptoms of AOS and agrammatism between our case and previously reported cases, there were subtle differences in the lesions. The distributions of lesions suggested they were a result of chronic ischemic dysfunction caused by moyamoya disease. Our case was characterized by rapid recovery of the urge to speak despite damage to the ACA region, leaving only prosodic deficits. In adult moyamoya disease, chronic ischemic symptoms and functional reorganization may have some influence on brain distribution of language functions, including language lateralization.