病例报告：青年卒中后重度Broca失语合并葡萄糖-6-磷酸脱氢酶缺陷1例

Case Report: Severe Broca Aphasia after Young Adult Stroke Complicated with Glucose-6-Phosphate Dehydrogenase Deficiency

摘要: 近年来，青年卒中发病率逐年上升，卒中后失语是其主要致残后遗症。其中重度Broca失语的康复预后差、干预难度高。本病例报告分析1例30岁青年男性左侧基底节–放射冠区大量脑出血患者经去骨瓣减压、颅骨修补术后，遗留重度Broca失语，同时合并葡萄糖-6-磷酸脱氢酶(G6PD)缺乏症。诊疗全程严格遵循G6PD药物指南筛选药物，规避溶血相关用药风险，同步开展规范降压、改善认知、缓解痉挛药物干预，搭配肢体功能训练、抗痉挛手法、系统化言语矫治与计算机认知训练综合康复方案。经2周系统干预后，患者言语命名、复述能力较前恢复。结合近年相关研究分析，G6PD缺乏可协同高血压加重脑血管损伤、放大出血后氧化应激损伤并限制临床用药选择，需严格把控用药安全。虚拟现实、脑机接口等新型言语康复技术可显著提升重度失语患者远期交流功能，为本类复合病例康复提供新思路。本例转归证实，在保障G6PD患者用药安全基础上开展早期多维度综合言语康复，可有效改善青年脑出血后重度Broca失语多重神经功能缺损。

Abstract: In recent years, the incidence of stroke among young adults has steadily risen. Post-stroke aphasia represents a major disabling sequela, with severe Broca’s aphasia carrying a particularly poor rehabilitation prognosis and considerable intervention difficulty. This case report describes a 30-year-old male patient with a massive intracerebral hemorrhage in the left basal ganglia-corona radiata region, who presented with severe Broca’s aphasia following decompressive craniectomy and cranioplasty. The patient also had a concurrent glucose-6-phosphate dehydrogenase (G6PD) deficiency. Throughout diagnosis and treatment, medications were strictly selected according to G6PD medication guidelines to avoid the risk of hemolytic complications. Additionally, standardized antihypertensive therapy, cognitive enhancement, and spasticity-relieving pharmacotherapy were administered, combined with a comprehensive rehabilitation program including limb function training, anti-spasticity techniques, systematic speech therapy, and computer-based cognitive training. After two weeks of systematic intervention, the patient’s naming and repetition abilities improved relative to baseline. Based on a review of recent relevant studies, G6PD deficiency may synergistically exacerbate cerebrovascular injury in the presence of hypertension, amplify oxidative stress damage following hemorrhage, and restrict available pharmacologic options, thereby necessitating strict adherence to medication safety protocols. Emerging speech rehabilitation technologies, such as virtual reality and brain-computer interfaces, may substantially enhance long-term communicative function in patients with severe aphasia and offer novel approaches for managing such complex cases. This case indicates that early, multidimensional, and comprehensive speech rehabilitation, implemented while ensuring medication safety in G6PD-deficient patients, can effectively ameliorate multiple neurological deficits associated with severe Broca’s aphasia after intracerebral hemorrhage in young adults.