WERNICKES REGION - WHERE IS IT
WERNICKES REGION - WHERE IS IT
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DOI：
10.1111/j.1749-6632.1976.tb25546.x
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发表时间：
1976-01-01
影响因子：
5.2
通讯作者：
BOGEN, GM
中科院分区：
文献类型：
--
作者：
BOGEN, JE;BOGEN, GM
在这个问题上，第一个问题无论从逻辑上还是从时间上来说都是：大脑的病变（局灶性损伤）是否会导致语言的丧失而不导致智力的丧失？这是最初的问题，仍然被许多人激烈争论。大部分的热量是由于问题的措辞方式。假设我们相对地这样表述：大脑的损伤是否会导致语言能力的缺陷远远超过伴随而来的智力缺陷？这样问，几乎所有人都会回答是的。有一些值得尊敬的人仍然认为，任何因大脑损伤而丧失语言的人都必然伴随着智力的丧失。同样，也有同样值得尊敬的人反复向我们表明，尽管有严重的失语症，智力也可以得到保留。双方无疑都是正确的。但是，当这个问题以相对的方式重新措辞时，这两种论点的力量在很大程度上都消失了。当然，智力丧失（或保留）的程度取决于人们如何测量智力;但除了严格的语言测量外，几乎所有测量的答案都是肯定的。事实上，如果答案不是肯定的，那么就不会有失语症这种东西，因为”失语症”这个词在当代的用法中就是”大脑病变导致的选择性语言丧失”。一旦我们都理解了失语症这种东西，我们就进入了第二个问题。它是：人们能否指出大脑中可能发生失语症性病变的部位？同样，答案是肯定的--失语症性病变发生在右利手的人的右半球，发生率为1%，最多可能为2%。如果你有一个人，他肯定是右撇子，他有一个大脑损伤，导致语言能力的丧失远远超过智力的丧失，那么损伤在左半球的几率是50比1。事实上，人们可以比这更好地本地化。病变不太可能位于左枕极。它更不可能位于左颞极，也不太可能（尽管不是不可能）位于左额极。因此，通过这种消极的方式，我们可以在一定程度上缩小失语症病变的范围。还有第三个问题，由Wernicke在1874年提出：失语症不止一种吗？换句话说，当一个人在丧失语言能力的同时相对保留了一般智力时，这种语言能力的丧失会是一种以上的丧失吗？当我们看病人的时候，很明显他们是不同的。问题是，是否应该强调这些差异，以及如何强调？失语症的分类几乎和失语症学家一样多。改写这第三个问题似乎无助于这一论点，这一论点已经持续了世纪。用莱尔米特和戈蒂埃的话说：2
In this subject, the first question both logically and chronologically was and is: Can a lesion (focal damage) of the cerebrum cause a loss of language without causing a loss of intelligence? That is the original question, still debated hotly by many people. Much of the heat is attributable to the way in which the question is phrased. Suppose we phrase it relatively, as follows: Can a lesion of the cerebrum produce a deficit in language that is far in excess of the concomitant deficit in intelligence? Asked in this way, almost everyone would answer yes. There are worthy persons who are still arguing that anyone who has a loss of language from a cerebral lesion must have some accompanying loss of intelligence. Similarly, there are equally worthy persons recurrently showing us that intelligence can be preserved in spite of severe aphasia. Both parties are undoubtedly correct. But the force of either argument is largely dissipated when the question is rephrased in the relative way. Of course, how much intelligence is lost (or retained) depends upon how one goes about measuring intelligence; but with almost any measures, except those strictly linguistic, the answer will be yes. Indeed, if the answer were not yes, there would not be such a thing as aphasia, since a" selective loss of language from a cerebral lesion" is what the word" aphasia" means in contemporary usage.Once we all understand that there is such a thing as aphasia, we come to a second question. It is: Can one indicate those places in the cerebrum where an aphasiogenic lesion is likely to occur? Again the answer is yes-an aphasiogenic lesion occurs in right-handed people in the right hemisphere I% of the time, perhaps 2% at most. If you have a person who is definitely right-handed, and he has a cerebral lesion that produces a loss of language far out of proportion to the loss of intelligence, the odds are about 50 to I that the lesion is in the left hemisphere. Indeed, one can localize better than that.. It is rather unlikely that the lesion will be in the left occipital pole. It is even less likely that it will be in the left temporal pole and it is very unlikely, although not impossible, that it will be in the left frontal pole. So, in this negative way, we can narrow down to some extent where an aphasiogenic lesion will occur. There is a third question, raised by Wernicke 1 about 1874: Is there more than one kind of aphasia? In other words, when a person suffers linguistic loss with relative preservation of general intelligence, can the linguistic loss be of more than one kind? When we look at the patients, it is obvious that they are different. The question is, should those differences be emphasized, and how? There are almost as many classifications of aphasia as there are aphasiologists. Rephrasing this third question does not seem to help with this argument, which has continued unabated for over a century. In the words of Lhermitte and Gautier: 2