全失性失語症病因之探討

Global aphasia is the most severe form of language impairment that occurs following focal brain damage. Since communication and neurological functions in patients with global aphasia are seriously impaired, it is a real challenge to the rehabilitation team. The study was designed to determine the etiology of global aphasia, to find out any relationship between different etiology and age or sex. Fifty-one patients with global aphasia attending to the Department of Physical Medicine and Rehabilitation of National Taiwan University Hospital from June 1990 to May 1993, were surveyed for the etiology of aphasia. Of the 51 patients (33 males and 15 females) , the mean age was 56.1±14.5 years. The etiology could he classified into 2 groups; group 1,vascular etiology, including 22 cerebral infarction, 16 cerebral hemorrhage, 3 cerebral aneurysm, 1 arterio-venous malformation; group 2, non-vascular etiology, 7 traumatic brain injury, 1 brain tumor and 1 brain abscess. Patients with vascular etiology were predominant in global aphasics (p＜0.05). In view of age and gender, male patient was predominant in patients with traumatic brain injury and cerebral hemorrhage (p＜0.05), but no difference in the group of cerebral infarction. There was also no difference in the mean age between patients with vascular etiology and traumatic brain injury. As for vascular origin, all global aphasic patients caused by cerebral infarction were the victims of middle cerebral artery territory infarct. The sample included 14 full territory infarct, 6 subcortical infarct and 2 posterior infarct. The majority of these cases was caused by full territory infarct. Putaminal hemorrhage could be grouped into 3 groups according to the volume of hematoma : large (＞35ml), medium (16-35ml) and small (＜15ml).In our series of 14 cases of putaminal hemorrhage with global aphasia, 10 cases had large hematoma, 4 cases medium hematoma, but none with small lesion of hemorrhage. It is obvious that global aphasia is usually associated with large hematoma. This study investigated different factors associated with global aphasia, including age, sex, etiology, lesion site and size. Factors which related to the prognosis of global aphasia will be presented in the subsequent study.