LB064-066 晟維

LB064-066 晟維
Chapter 2 – Section 3

Some indications suggest that several other subcortical structures are involved in language and speech. Hartmann-v. Monakow (1965) and Hartmann-v. Monakow and Lenneberg (in preparation) have studied a series of patients with speech and language disorders resulting from surgical diencephalic lesions made in attempts to cure parkinsonism. Some of these patients suffered disorders of expression that were similar to cortically produced motor aphasias. Dr. E. M. Housepian (personal communication) has observed a pure jargon aphasia quite frequently, resulting from either pallidotomy or thalamotomy. These symptoms may last for several weeks before they clear up, although permanent sequelae have been observed in the Hartmann-v. Monakow series. One case of permanent, total language arrest has come to the author's attention through the courtesy of Dr. F. Ervin, and similar cases have also been encountered by other neurosurgeons. Van Buren (1963) has reported "aphasoid" disturbances due to stimulation in the head of the caudate nucleus. He has interpreted the symptom as an arrest of the impulse to speak. These disorders are independent from any cortical lesions, and most of them cannot be predicted on the grounds of cerebral dominance. In Housepian's opinion, some may be due to disruptions in the dorso-lateral thalamic nuclei.
有些跡象暗示了許多其他皮質下組織與語言和言語相關。Hartmann-v. Monakow (1965) 及 Hartmann-v. Monako與Lenneberg （準備中），研究了許多因藉外科手術破壞間腦來治療帕金森氏症候群而產生說話及語言障礙的病人。其中有些病人的表達障礙跟與皮質產生的運動失語症相似。Dr. E. M. Housepian (私人發表) 時常觀察到因蒼白球切開或丘腦切除而產生的單純亂語失語症。這些症狀在消除前可能會維持好幾個星期，而Hartmann-v. Monakow也觀察到永久性的後遺症。筆者也因為Dr. F. Ervin而注意到一個永久性語言完全遏止的案例，而其他神經外科醫生也發現相似的案例。Van Buren (1963) 指出 aphasoid 擾亂是由於尾核前端的刺激所致。他將這種症狀解釋為刺激說話的神經脈衝的遏止。這些障礙跟任何皮質損傷無關，大部分的障礙都無法以大腦支配的觀點來作預測。Housepian認為，有些障礙可能是因為背側丘腦核的破裂所致。

Motor speech disorders may result from either stimulation or lesion of the ventro-lateral nucleus of the thalamus (Guiot et al., 1961, and Housepian, personal communication). The most common symptom is either an acceleration or a slowing down of the rate of speech.
運動語言的障礙可因腹側丘腦核的刺激或傷害而產生(Guiot et al., 1961, 及 Housepian 私人發表)。最常見的症狀是說話速度變快或變慢。

Surgery of the thalamus and its electrophysiological exploration in man has not yet progressed far enough to give us a rounded picture of its precise role in the perception and production of language. However, the evidence is strong that speech and language are not confined to the cerebral cortex.
人類丘腦外科學及其電生理學上的探索，尚未進步到能夠全面性的描述其在語言的接收及製造所扮演的角色。但強而有力的證據指出，言語與語言並非僅限於大腦皮質。

There is one other region in the mid-brain that may also be involved in motor coordination of speech. This is the gray matter that either surrounds or is adjacent to the ventral side of the aqueduct. On the rostral end it is bounded by the floor of the third ventricle, and in its caudal extent it reached down to the level of the fourth ventricle. Apparently, lesions in this area cause dysarthria in children more easily than in adults. The disturbance is one of articulatory coordination and not paralysis, because many of the patients so afflicted have no trouble chewing and swallowing or moving the articulatory organs, but they cannot control and coordinate the muscles to make them subserve speech. It is conceivable that a congenital deformity in this region may result in developmental anarthria such as described by Lenneberg (1962). Perception of language is not involved in these cases, and none of the typical aphasic symptoms is present. Children may acquire a complete understanding of language without ever having been able to produce intelligible words.
中腦的另一個區塊也許跟語言的運動協調有關。也就是包圍或鄰近腦導水管腹側的灰質。其柱狀末端截限於第三腦室壁，而其末端延伸達第四腦室的深度。顯然，與成人相較下，這個區域的損傷更容易導致兒童的發音困難。這樣的干擾並非癱瘓，而是一種發聲協調，因為許多受到嚴重干擾的病人能毫無困難的咀嚼、吞嚥、或是移動他們的發聲器官，但他們無法控制、協調發聲肌肉來說話。可想而知，這個區塊的先天畸形可能會造成發育中的發音不能，如同Lenneberg (1962) 所描述。以上的案例並不涉及語言接收，也沒有任何典型的失語症狀。兒童可能習得了完整的語言理解力，卻無法正確的發音。

The peri-aqueductal gray matter is the anatomical locus of neuro-physiological activity which, in many mammals, regulates coordination of vocalization and facial movements. Thus, there is anatomical homology and, in a sense, physiological homology as well. But the behavioral product is species-specific in each case. Lesions may interfere with coordination for mewing in cats, barking in dogs, and speech-sound-making in man.
周邊導管灰質為神經生理上的活動的解剖部位，其為許多哺乳動物用以調節發聲及臉部活動的協調。因此，顯示了解剖學上的相似性，某方面來說，也顯示生理學上的相似性。但行為結果卻是因物種而異。此部位的損傷會干擾貓叫、狗吠、及人類發聲的協調性。

The relationship between peri-aqueductal gray matter and vocalization has been known for more than twenty years, but not much attention has been paid to it. As far as I know, the first paper on the subject is due to Bailey and Davis (1942). They placed electrolytic lesions from the aqueduct in a number of cats. If the lesions were small, wild and emotional behavior was observed, including vigorous mewing and hissing; this would last about two days and then subside or in some cases result in extraordinary quietness.
周邊導管灰質與發聲之間的關係，已被發現二十幾年了，但卻沒什麼人注意到它。就我所知，第一篇相關報告來自Bailey和Davis (1942)。他們把自導管取出的electrolytic lesions置入幾隻貓的體內。如果lesions很小，便會觀察到粗野、激動的行為，像是大聲的貓叫和嘶嘶聲；這樣的情形持續兩天後便會消失，或是像某些案例一樣最後導致異常的安靜。

These first reports were followed by further and more precise experimental work (Kelly, Beaton, and Magoun, 1946), again using cats. These author found that destruction of per-aqueductal gray matter and adjacent tegmentum beneath the superior colliculi abolished or greatly reduced facio-vocal behavior. They found upon careful examination of the subjects that the deficit was specific to vocalization; they called it pure mutism, perhaps to distinguish it from akinetic mutism, which is due to hypothalamic lesions and is primarily a syndrome of apathy and disinterest. Purring was the only sound that was preserved after peri-aqueductal lesions. More recently, Skultety (1961) reported on similar experiments on dogs with the conclusion that, in order to produce mutism in dogs through peri-aqueductal lesions, "a complete cross-sectional damage of the structure must be accomplished at a level beneath the superior colliculi."
這頭幾份的報告引導了更進一步、更精密的實驗研究(Kelly, Beaton, and Magoun, 1946)，同樣的以貓為實驗對象。學者們發現位於上腦丘之下的周邊導管灰質與鄰近的大腦腳蓋，大大減少、或破壞了臉部運動行為。對患者仔細的檢查後，他們發現這樣的破壞都只和發聲有關；也許為了和「運動不能性啞症」卻區別，他們將此稱作「純啞症」，此症因視丘下部的損傷所致，同時也是神情呆滯和漠不關心的主要症狀。在周邊導管損傷後，低鳴的呼嚕聲是唯一存留下來的聲音。近期，藉由損傷周邊導管以導致狗瘖啞等相似實驗的結論，Skultety(1961)在發表中表示：「周邊導管結構上完全的跨區域破壞，必須深達上腦丘之下。」

In the absense of experiments on man, we must base our extrapolations on clinical experience. Bailey, Buchanan, and Bucy (1939) described tumors of the lining of the upper fourth ventricle (ependy-momas), which is a relatively common neoplasm in children, to be manifested by dysarthria and oculo-motor nerve disturbance. The impact of this evidence is that the mid-brain contains a fairly narrowly circumscribed locus which is of particular importance in motor coordination of speech.
因為缺少人體實驗，我們必須憑藉臨床實驗的推斷。Bailey, Buchanan, and Bucy (1939)描述了上第四腦室內層(ependy-momas)的腫瘤（其為兒童體內相當常見的贅瘤），藉由發音不良與動眼神經障礙而顯示。這個證據所帶來的影響是，中腦中相當細小的分界環繞部分，其在言語運動協調有特別的重要性

(4) Lateralization
(4) 側化

The most dramatic difference between the human brain and that of any other vertebrate is the appearance of hemispheric dominance or language specialization. Only in man do we find a behavioral function relatively clearly localized in just one of the two hemispheres.
人腦及其他脊椎動物的腦之間，最誇張的差別就是半腦管轄與語言特化。只有人類的行為功能相當清楚地座落在其中一個半腦內。

The phenomenon of laterality affects not only language but also, as is well-known, hand preference (and to some extent also preference in the use of eye, ear, and foot). Although the lateralization of language function cannot be traced phylogenetically for obvious reasons, that of limb-preference could be, at least theoretically. In apes and monkeys and even in some carnivores, it is common that an individual prefers one side of his extremities for a given behavior, but the distribution between right and left preference throughout the species appears to be random. Nor have cortical correlates been discovered for these individual preferences. It has been said of apes, for instance, that either of their hemispheres seems to function like man's right hemisphere; that is, the deficits that result from experimental lesions on either side of a monkey's brain bear similarities to the clinical deficits observed in man following right-hemispheric lesions.
側化的現象不僅影響了語言，還有眾所周知的慣用手（還有其他延伸的部位，如慣用眼、慣用耳、慣用腳等）。雖然語言的側化不像肢體的側化一樣可以系統化地回溯到某些明確的原因，但至少我們可以假設。猩猩、猴子、甚至是某些食肉動物，因特定行為而使用慣用邊的肢體是很常見的，但是以整個物種來看，慣用邊的左右的分佈卻顯得很隨機。也未發現能解釋個體的慣用偏好的皮質相關作用。有人提出（舉例來說）猩猩的左右腦都只有人類右腦的功能，也就是說，在猴子任何一邊的腦用實驗性損傷所造成的功能障礙，和從遭受右腦損傷的人所觀察到的臨床障礙相似。

In man, there are even asymmetries of a strictly structural nature, recently reviewed by v. Bonin (1962). They are not very marked and are revealed only through statistics, and their relevance to the asymmetry in function is entirely unknown. The individual measurements need not concern us, but the left hemisphere on almost all quantitative counts yields higher values than the right one.
在人體，甚至還有嚴格結構本質的不對稱，如v. Bonin (1962)近期的回顧。這些不對稱並不特定，只有透過統計才能察覺，而它們與功能中的不對稱性是否相關，也尚未查證。我們不需擔心個體的測量，但是左腦在各種量質的計算顯示了比右腦更高的重要性。

We have said that normally all parts of the brain interact. If language is primarily localized in the left hemisphere, we might ask what the role of the right hemisphere is with regard to speech and language. Even in the adult individual, where localization is more pronounced than in infancy, the right hemisphere may have some, though lesser, functions in language. Macdonald Critchley (1962) suggests that lesions in the right hemisphere may be followed by any one or more of the following deficits: difficulty with articulation, impairment of creative literary work, hesitations, difficulty in finding words, and difficulty in learning new linguistic material. The common denominator of these symptoms might be called verbal aspects of generally lowered intellectual efficiency. At any rate, there seem to be some language functions that are "reserved" to the right hemisphere.
我們已經討論過，通常大腦的每個部分都會交互作用。如果語言主要存在左腦，我們也許會問，關於語言和言語右腦又扮演了什麼樣的角色？甚至，成年人語言的局部化比在嬰兒期更明顯，右腦也許也有一些（儘管不多）語言功能。Macdonald Critchley (1962)提出，右腦的損傷可能會導致以下幾種障礙：發音困難、文學作品創作障礙、尋找詞彙的困難、學習新語材的困難。這些症狀的普遍起源也許可以稱作是常態降低智力效能的口語面向。無論如何，似乎某些語言功能「儲備」在右腦裡。

(Vocabulary)
subcortical《形》 皮質下的.
subcortical alexia 皮質下性失讀症,(大腦鉤回與視神經中樞間之連接受阻所致).

Diencephalic
diencephalon【解】間腦

parkinsonism 帕金森氏症候群
Parkinson’s disease 帕金森氏症：由於大腦核變性之進行性運動病患

motor aphasia 運動性失語症,(對文字語言不能表達)

jargon aphasia 亂語失語症,(像說夢話),(同gibberish aphasia).

pallidotomy《名》 蒼白球切開.

Thalamotomy《名》 丘腦切除.

Sequelae 後遺症,pl.sequelae[~ ](L.).

arrest《名》 停止;遏止

caudate necleus 尾核,(與側腦室有關,弧形灰色).
caudate《名》 (腦)尾核,(同caudatum).《形》 有尾的.
necleus《名》 1.核.2.細胞核.3.神經核(在中樞神經由很多神經細胞組成),pl.nuclei

disruption《名》 破裂,暴裂的狀況

dorso-lateral
dorso- 表示"背"

thalamic【解】丘腦的]
thalamic epilepsy視丘性癲癇,(由視丘疾病所致).
thalamic radiation丘腦紋線,(其纖維連接於丘腦與皮質,沿內膜而行又可分成四股,前,上,後,及下四種放射).

ventro-lateral
ventro- 表示"腹";"腹部"

electrophysiological《名》 電生理學

midbrain《名》 中腦,(同mesencephalon,由原腦囊之中間囊而來).

ventral《形》 1.腹的.2.腹面的

aqueduct《名》 導水管,導管
cerebral aqueduct腦導水管,(在中腦,連接第三與四腦室).

rostral 【建】(柱子等)有喙形艦首裝飾的 【動】有嘴的;有喙的

ventricle 《名》 室,(腦或心).

Caudal《形》 尾部的.

Dysarthria《名》 發音不良,發音困難,(由神經肌肉障礙所致).

Subserve 有利於 / 對...有幫助

congenital deformity
congenital《形》 先天性的,天生的,(與acquired相反).
Deformity《名》 變形;畸形.

Anarthria《名》 發音不能,(由發音關節障礙引起).

peri-aqueductal

electrolytic 《形》 電解的.

tegmentum《名》 1.蓋.2.大腦腳蓋,pl.tegmenta

colliculi
colliculus《名》 阜,丘,(一種小隆起,解剖名),pl. colliculi[~ ],(L.),[NA].

facio-vocal
facio- 表示「面」

pure mutism
mutism《名》 1.啞.2.緘默,(狀態).

akinetic mutism運動不能性啞症,(發音困難).

hypothalamic《形》 視丘下部的.

Apathy《名》 神情呆滯

extrapolations 推斷 / 【統】外推(法)

ependy-momas
ependyma《名》 室管膜,(腦室與脊椎神經中央管之內膜)

neoplasm《名》 新生質;贅瘤;贅生物;瘤腫.

oculo-motor
ocul(o)- 表示「眼」之字首

Circumscribed《形》 局限的,環繞分界的,被環繞為界的

Vertebrate《名》 脊椎動物.《形》 有椎柱的.

phylogenetically
phylogenetic 系統發生的 / 動植物種類史的

carnivore《名》 食肉動物

extremity《名》 1.遠端.2.上肢,下肢.3.手,足.