Abstract
A 75-year-old right-handed man was admitted to our hospital because of progressive disturbance o speech and clumsiness of the right hand. Before admission, the blood pressure (systolic/diastolic) of the pa tient had been kept under 120 mmHg/70 mmHg with antihypertensive drugs. Over 10 months, despite thf administration of antiplatelet drug, his language function and dexterity of the right hand had deteriorated in stepwise fashion. Brain MRI revealed fresh infarction in the left frontal lobe and old infarction in the lef parieto-occipital watershed territory. MRA demonstrated severe stenosis of the left internal carotid artery SPECT showed a decrease in left hemispheric perfusion, particularly in the anterior and posterior watershec territories. The Standard Language Test of Aphasia identified a decrease of spontaneous speech and distur bance of auditory comprehension, objective naming and repetition, indicative of mixed type aphasia. Neuropsychological examinations disclosed limb-kinetic apraxia and ideomotor apraxia, predominantly on the right side. Discontinuance of the antihypertensive drugs resulted in improvement of the aphasia and apraxia On the basis of the clinical course and findings of neuroimaging, the progressive aphasia and apraxia appearec to be caused by the sequential occurrence of hemodynamic infarctions due to excessive antihypertensive therapy. We conclude that physicians should pay careful attention to fluctuations of higher brain functions it patients with stenosis or occlusion of the main vessels during antihypertensive therapy.
