前島 伸一郎

Objective: Unilateral spatial neglect (USN) is one of the major behavioral disturbances in patients with cerebral lesions and often impairs the patients' independence in activities of daily living (ADL). Although many studies have addressed the mechanism and assessment of USN, there have been only few reports on rehabilitation strategies for patients with USN. The present study examined whether family participation can contribute to an improvement in USN following an acute stroke. Design: This study compared the improvement at 3 weeks among patients treated with conventional exercise sessions and a program including the participation of family members. The study followed 34 stroke patients with hemiparesis and USN. Twenty had family participation in their therapy. The severity of USN was measured using the Behavioral Inattention Test (BIT) and a laterality index (LI). Mobility was assessed using the River-mead Mobility Index (RMI), and ADL were assessed using the Barthel index. Results: The results showed a relationship between BIT score improvement and family participation, and the BIT score improvement reflected the LI improvement. The RMI and BIT scores showed that ADL improved more with than without family participation. Conclusion: Family participation improved not only the mobility but also USN, suggesting that it can make important contributions to acute stroke rehabilitation. Copyright (C) 2010 S. Karger AG, Basel

A 78-year-old right-handed man presented with mild right hemiplegia and impaired deep sensation on his right side. He had no aphasia, but showed Gerstmann's syndrome which is characterized by four primary symptoms: finger agnosia, right-left disorientation, agraphia, and acalculia. A cranial CT revealed hemorrhagic lesions in the left thalamus, and single photon emission CT showed decreased regional cerebral blood flow in the superior portion of the left temporoparietal lobe, especially angular gyrus area. It is infered that in this case, corticofugal fibers from the thalamus to the parietal lobe had been damaged by hemorrhage, secondarily causing decreased function of the cerebral cortex.

50歳代男。嘔吐と意識障害で発症した。もやもや病によるくも膜下出血と診断され、保存的治療を受けた。第11病日に脳血管攣縮により右側頭頭頂後頭葉に脳梗塞を発症して言語症状が出現した。理解が比較的良好で、自発話は流暢であるものの表出面全てにおいて音韻性錯語を認め、その修正行動もあったことから、伝導失語を呈していると考えた。発症1ヵ月後の評価では、自発話では錯語が減少した。呼称は、音韻性錯語の出現頻度は増加したが、初回では喚語困難のために無反応であったものが喚語されるようになった結果であった。また、音韻性錯語となっても、それらすべてにおいて自己修正後に正答可能となった。復唱は、有意味語は4モーラまで可能となったが、無意味語は依然として2モーラまでで、有意味語との差が明確となった。書字は、錯書が減少して文レベルの書字も可能となった。