That's right! Language comprehension beyond the left hemisphere.
That's right! Language comprehension beyond the left hemisphere.
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这是正确的！
DOI：
10.1093/brain/awy291
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
Hillis,ArgyeE
中科院分区：
文献类型：
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作者：
Sheppard,ShannonM;Hillis,ArgyeE
中风后获得性语言障碍与左半球损伤密切相关。当在右半球中风的情况下观察到语言困难时，患者通常被认为具有非典型的功能解剖结构。通过系统地将脑损伤患者的行为和病变数据与神经正常参与者的功能性 MRI 数据整合起来，我们研究了右半球中风何时以及为何会导致语言障碍。实验 1 研究了患有单侧中风且右半球 (n= 109) 或左半球 (n= 369) 受损的惯用右手患者。最常受损的语言任务是：右半球中风后听觉句子与图片的匹配；以及左半球敲击后的口头图片描述。对于那些在右半球中风后出现听觉句子与图片匹配障碍的人，大多数（n = 9）在知觉（视觉或听觉）和语言（语义、语音或句法）处理测试中表现正常。实验2发现，与其他75名同样患有右半球中风但在听觉句图匹配任务上没有受损的患者相比，这9名患者的上纵束背侧部分和右额下沟的损伤明显更多。这些右半球区域的损伤导致 67% 的患者出现长期言语理解困难。实验 3 和 4 在两组 25 名神经系统正常个体中使用功能性 MRI，结果表明，在实验 2 确定的区域内，右额下沟通常是通过以下方式激活的：（i）听觉句子与图片匹配； (ii) 当对语言和非语言工作记忆的要求较高时进行一对一匹配。总之，这些实验表明，右下额叶皮层有助于正常言语理解所需的语言和非语言工作记忆能力（执行功能）。我们的结果将之前关于右下额皮质在执行处理中的作用以及执行处理在句子理解中的作用的不相关文献联系起来；这反过来又有助于解释为什么之前有报道称，在左半球中风后语言功能恢复期间，右下额叶活动会增加。我们研究结果的临床相关性是，右半球中风对语言的不利影响（i）比预期大得多； (ii) 右额下沟损伤后经常观察到； (iii) 任务相关； (iv) 与左半球中风后观察到的损伤类型不同； (v) 可能导致长期的缺陷，而 (vi) 不是非典型语言偏侧化的结果。
Acquired language disorders after stroke are strongly associated with left hemisphere damage. When language difficulties are observed in the context of right hemisphere strokes, patients are usually considered to have atypical functional anatomy. By systematically integrating behavioural and lesion data from brain damaged patients with functional MRI data from neurologically normal participants, we investigated when and why right hemisphere strokes cause language disorders. Experiment 1 studied right-handed patients with unilateral strokes that damaged the right (n= 109) or left (n= 369) hemispheres. The most frequently impaired language task was: auditory sentence-to-picture matching after right hemisphere strokes; and spoken picture description after left hemisphere strokes. For those with auditory sentence-to-picture matching impairments after right hemisphere strokes, the majority (n= 9) had normal performance on tests of perceptual (visual or auditory) and linguistic (semantic, phonological or syntactic) processing. Experiment 2 found that these nine patients had significantly more damage to dorsal parts of the superior longitudinal fasciculus and the right inferior frontal sulcus compared to 75 other patients who also had right hemisphere strokes but were not impaired on the auditory sentence-to-picture matching task. Damage to these right hemisphere regions caused long-term speech comprehension difficulties in 67% of patients. Experiments 3 and 4 used functional MRI in two groups of 25 neurologically normal individuals to show that within the regions identified by Experiment 2, the right inferior frontal sulcus was normally activated by (i) auditory sentence-to-picture matching; and (ii) one-back matching when the demands on linguistic and non-linguistic working memory were high. Together, these experiments demonstrate that the right inferior frontal cortex contributes to linguistic and non-linguistic working memory capacity (executive function) that is needed for normal speech comprehension. Our results link previously unrelated literatures on the role of the right inferior frontal cortex in executive processing and the role of executive processing in sentence comprehension; which in turn helps to explain why right inferior frontal activity has previously been reported to increase during recovery of language function after left hemisphere stroke. The clinical relevance of our findings is that the detrimental effect of right hemisphere strokes on language is (i) much greater than expected; (ii) frequently observed after damage to the right inferior frontal sulcus; (iii) task dependent; (iv) different to the type of impairments observed after left hemisphere strokes; and (v) can result in long-lasting deficits that are (vi) not the consequence of atypical language lateralization.