Impairment of selective vowel articulation in a patient with anarthria following infarction of the left central gyrus and adjacent subcortical area

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  • Shibakiri Keiko
    Neuropsychology Section of Department of Rehabilitation, Hyogo Brain and Heart Center at Himeji
  • Yoneda Yukihiro
    Neurology Service, Hyogo Brain and Heart Center at Himeji
  • Yamadori Atsushi
    Department of Humanities and Sciences, Kobe Gakuin University

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  • 母音／ｉ／，／ｅ／の産生困難が持続した左中心回の皮質・皮質下梗塞による失構音の１例

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Abstract

   We report on a patient with anarthria following an ischemic stroke of the left central gyrus and adjacent subcortical area, who continuously exhibited selective impairment in articulation of the two vowels /i/and/e/.<br>   The patient was a 72-year-old right-handed male with a history of myocardial infarction who suddenly developed mutism and right hemiparesis. MRI showed an infarction in the left pre- and post-central gyrus, extending to the adjacent subcortical area, and other small old infarctions in the bilateral subcortical areas. The lowest part of the left precentral cortex was intact. During the acute phase of illness, the patient was mute but could fully communicate by means of writing and gestures. He exhibited a buccofacial apraxia and minor agramatism in writing. Over the next few months, despite complete articulations of the other three vowels and all consonants except /j/, the patient selectively and persistently showed impairment in articulations of the two vowels /i/and/e/. In emotional situations, the patient could often produce the two vowels.<br>  We speculate that a combination of anarthria and dysarthria, the former characterized by inconsistent dysarticulation and the latter by consistent dysarticulation, constitutes a possible mechanism for producing a unique linguistic impairment of this kind in this patient. We also discuss possible an involvement of “anterior opercular syndrome” characterized by automatico-voluntary dissociation of the lower cranial nerve functions.

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