Abstract
A 62-year-old right-handed man with diabetes mellitus, suddenly experienced difficulty in writing.A physical examination at 40 days after the onset of this symptom was unremarkable. He exhibited non-fluent speech with a small voice. His performances on the Standard Language Test of Aphasia (SLTA) demonstrated moderate impairments in writing and animal naming, and slight impairment in object naming. Brain MRI demonstrated localized infarcts in the left centrum semiovale and left lateral occipilotemporal gyrus. 99mTc-HMPAO SPECT revealed widespread hypoperfusion in the left middle cerebral artery (MCA) territory. Caroid ultrasonography suggested bilateral internal carotid artery occlusion, which was proved by cerebral angiography. The patient underwent left superficial temporal-middle cerebral arterial anastomosis, and soon after the surgery his spontancous speech and writing improved. At 2 months after the surgery, SPECT demonstrated improvement of the hypoperfusion in the left MCA territory, and the SLTA failed to dctect impairments any more. We speculate that not the infarcts but the widespread hypoperfusion area had caused his language disorder. Extracranial-intracranial bypass surgery may improve aphasia due to cerebral infarction in some cases. Screeing tests on the vascular system, employing SPECT and carotid ultrasonography, are vey important.
