Neurology:病例:表现为多成分失写症的左侧颞叶癫痫

2020-02-21 zyx 神经科病例撷英拾粹

58岁女性,临床诊断为颞叶癫痫,表现为发作性定向力障碍和现实感丧失,发作后期出现失语且有写句子意图,但实际绘制的确是随机图案(

58岁女性,临床诊断为颞叶癫痫,表现为发作性定向力障碍和现实感丧失,发作后期出现失语且有写句子意图,但实际绘制的确是随机图案(图1)。外院MRI检查正常。然而,我院3T癫痫序列MRI发现左侧杏仁核病变,无增强(图2)。该名患者绘制的图案反映了表现为异形存储(allgraphic storage)能力受损及失语的多成分失写症。尽管患者语言依赖的符号图形表达能力受损,但非语言依赖的符号图形表达能力仍保持完整。这提示后颞叶/颞枕叶交界处参与了癫痫的传播。


(图1:根据患者的说法,“想不出要写的字母——只是从形状开始”)


(图2:A:冠状位T2WI;B:FLAIR;左侧杏仁核可见一卵圆形FLAIR高信号病灶;此为胚胎发育不良性神经上皮瘤的典型特征,这是一种囊性“泡状”皮质内肿瘤,通常累及颞叶;节细胞胶质瘤也常见于颞叶,但可有强化和钙化)

原始出处:Ulloa C, Ortiz-Guerrero G, Pearson C, et al. Ictal multicomponent agraphia in left temporal lobe epilepsy. Neurology. 2020 Jan 7;94(1):42-43. 

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    2020-07-30 ms3000001681954499

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    2020-06-18 yinhl1978
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