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PubMed1988

Alexia with agraphia due to the left posterior inferior temporal lobe lesion--neuropsychological analysis and its pathogenetic mechanisms.

We report three cases of alexia with agraphia due to the left posterior inferior temporal lesions. In Case 1, the reading disability was more prominent in the use of Kana than in the use of Kanji, which is similar to previously reported cases of alexia with agraphia due to angular gyrus lesion. In Cases 2 and 3, by contrast, the reading disability was more prominent in the use of Kanji than in the use of Kana. In spontaneous writing and dictation, the disability was more pronounced in the use of Kanji compared with the use of Kana. In each of the three cases, the CT scan and positron emission tomography showed a localized lesion in the lower part of the left posterior temporal lobe. A typical form of an alexia with agraphia could be caused not only by the left angular lesion but also by the left posterior inferior temporal lesion. We discuss the neuropsychological analysis and pathogenetic mechanisms of alexia with agraphia due to the left posterior inferior temporal lesion in the comparison of alexia with agraphia caused by the left angular lesion.

Aged↗
PubMed1987

Selective Kana agraphia: a case report.

We present a Japanese man with selective Kana (phonogram) agraphia as a sequela of two cerebral infarctions in a part of the left angular gyrus and its adjoining posterior superior temporal gyrus and the left corona radiata. The agraphia of this patient showed the following features: (1) His writing difficulty was greater for Kana than for Kanji (ideogram) when a word was polysyllabic. (2) Kana errors consisted of perseveration and substitution with another letter, resulting in jargon agraphia. (3) This jargon agraphia often contained a correct number of letters for a target word. Based on these findings, we speculate that the basic defect of this agraphia lies in the process of converting an acoustic word image into a Kana motor grapheme sequence.

Agraphia↗
PubMed2001

Phonological agraphia following a focal anterior insulo-opercular infarction.

Following a unique infarction, restricted to the left anterior insula and the adjacent part of the intrasylvian frontal opercular cortex, an 83-year-old right-handed patient acutely developed a severe speech disorder that evolved into mere mutism within a few hours. After rapid recovery from mutism, oral language was characterized by severe apraxia of speech. In-depth language investigations further disclosed an isolated, highly selective disturbance of the spelling system (phonological agraphia) which resolved rapidly. One year after onset of neurological symptoms, the apraxia of speech had almost completely receded. The anatomoclinical findings in this first representative of pure and nearly isolated phonological agraphia complement previous neuroanatomical and neurolinguistic accounts of phonological agraphia. The data not only seem to enrich current insights in the anatomical locus for phonological agraphia, they also seem to contribute to a further delineation of the insular role in phonologically mediated aphasic manifestations.

Aged↗
PubMed1988

[The difference in writing disorders in primary agraphia and congenital dyslexia and their clinical relevance].

If after a brain injury reading and writing disturbances persist, the question is: primary agraphia or writing disorders due to dyslexia? If the anamnesis cannot answer this question, a decision is possible by means of four essential differences between writing disorders on the background of primary agraphia and those associated with dyslexia: 1. Agraphic persons correct their mistakes, dyslectics do not. 2. The word formations (paragraphias) due to primary agraphia do not bear close phonetical resemblances, whereas word formations by dyslectic persons are plainly phonetical. 3. Agraphics persevere, dyslectics do not. 4. In primary agraphia, the patient will also show difficulties in writing numbers; in a dyslectic disorder, he/she will not.

Adolescent↗
PubMed1994

[Agraphia of Gerstmann syndrome--attempt at characterization].

A review is given of well documented cases of Gerstmann's syndrome covering one century from 1888 to 1991 complemented by two own observations, Convergencies as well as divergencies are pointed out. It is concluded, that although aphasia may be an accompanying condition, aphasic agraphia as described in linguistic terms is not a sufficient explanation of agraphia in Gerstmann's syndrome which implies spatial-graphic particularities like disturbances of symmetry, reduplications of strokes, defective line orientation, choice of a different letter type and occurrence of nonsense characters not contained in the alphabet. Literal paragraphs may appear as well, while semantic errors are virtually lacking. These features are known to occur in apractic or constructive agraphia whose localisation is usually in the left angular/subangular region coincident with a disconnection from homotopic right hemisphere areas by damage of commissural fibres. Lesions of these non-dominant areas may lead to spatial agraphia.

Aged↗
PubMed2004

"Blocking" lexical competitors in severe global agraphia: a treatment of reading and spelling.

Severe global agraphia in Patient MM is analyzed via anagram spelling. Errors in word spelling reflect conflict among lexical competitors and "blocking" of semantic errors by sublexical and lexical cues. Lexical graphemic competition predominates in the context of MM's nearly absent sublexical transcoding of phonemes into graphemes. His orthographic lexicon is severely impaired, resulting in poor activation of lexemes and impaired activation and inhibition of the grapheme level in spelling. In MM's multiple revisions of spelling errors, graphemes from more than one lexical competitor persist in an active state simultaneously. Experimental treatment addressed MM's impaired sublexical reading and spelling, and facilitated sentence spelling through functional computer tasks. Spelling treatment resulted in evolution of MM's global agraphia to surface agraphia. MM's spelling performance supports the claim that lexical and sublexical processes interact during normal spelling, and shows that severe global agraphia is amenable to treatment.

Agraphia↗
PubMed1989

[Pure agraphia. Apropos of 2 cases].

Pure agraphia is a disorder of written language without aphasia, alexia or apraxia. Its existence has long been disputed. We report 2 cases due to a left parietal hematoma. In the first patient, with a deep precuneate lesion, agraphia included disorders in handwriting and orthographic problems in copying or writing from dictation with the two hands. The second patient, with a lesion of the postero-inferior part of the left angular gyrus, made errors in choice and combination of letters during dictation, whereas these same letters were well-written and copying was normal. The first cases of pure agraphia were ascribed to frontal lesions and then confusional states. Current opinion tends to implicate parietal lesions of various types: superior or inferior, internal or external. Findings in the present 2 cases and those reported indicate that pure parietal agraphia is heterogeneous.

Aged↗
PubMed1987

[A case of alexia with agraphia following left occipital lobe].

Since Dejerine reported cases of alexia with agraphia in 1891 and of pure alexia in 1892, it is generally said that the former may occur due to the lesion of the left angular gyrus and the latter due to that of the medial inferior area of the left occipital lobe. In this article, we reported a case of alexia with agraphia who had the main lesion in the medial inferior area of the occipital lobe of the left hemisphere. A 62-year-old right-handed male showed alexia with agraphia. CT scan and single photon emission CT revealed the main lesion in the medial occipital area on the left side. Alexia with agraphia of the patient was characterized as follows: with regard to reading, though his recognition of forms as letter was nearly spared, he could neither read letters or words nor differentiate Kana- from Kanji-letters. Paralexic errors included confusion of Kana and Kanji. He manifested no kinesthetic facilitation in reading. Regarding writing, his disturbances were more severe in Kanji-writing, but there were paragraphia and difficulty of letter-form evocation even in Kana-writing. He could not write spontaneously or to dictation. His copying of letters was also disturbed. Since it is said that there is no difference between Kana- and Kanji-disturbance in Japanese pure alexics, an aspect of alexia of the patient may be common to pure alexia.(ABSTRACT TRUNCATED AT 250 WORDS)

Agraphia↗
PubMedDate not supplied

Use of agraphia in subtyping of Alzheimer's disease.

Agraphia, the inability to write a sentence, was studied in 46 Alzheimer's disease (AD) patients to explore the potential usefulness of this measure in the subtyping of AD. In this sample there was significant correlation between the agraphia and the severity of the cognitive impairment. However, there was no correlation between agraphia and the patients' age, age at onset, duration of the illness, presence of family history of AD, cerebrospinal fluid choline and acetylcholinesterase levels. Agraphia does not seem to help in the subtyping of Alzheimer disease.

Journal Article↗
PubMed2004

Alexia without agraphia following biopsy of a left thalamic tumor.

Alexia without agraphia is a rare disconnection syndrome characterized by the loss of reading ability with retention of writing and verbal comprehension. We report a patient who developed alexia without agraphia after undergoing a biopsy for a malignant glioma involving the left thalamus. A 15-year-old right-handed male presented with 3 days of severe headache, and vomiting, and 1 month of blurry vision in his right visual field. Magnetic resonance imaging of the brain disclosed a large exophytic mass originating in the left thalamus, with mass effect and hydrocephalus. The patient underwent biopsy of the left thalamic mass via a transcallosal approach. Postoperatively, the patient complained of inability to read or identify letters. Examination revealed alexia without agraphia. The syndrome of alexia without agraphia can be rarely caused after surgery. A transcallosal procedure through the splenium of the corpus callosum may disrupt the visual association fibers traveling from the right occipital cortex to the left angular gyrus. In our case the syndrome occurred because of a preexisting right homonymous hemianopia resulting from a left thalamic tumor.

Adolescent↗
PubMed1980

Left unilateral agraphia and tactile anomia. Disturbances seen after occulusion of the anterior cerebral artery.

A 53-year-old right-handed Japanese man had a callosal disconnection syndrome associated with an occlusion of the left pericallosal artery. Computerized tomography scan confirmed a left medial lesion affecting the cingulate gyrus, the paracentral lobule, the precuneus of the left hemisphere, and most probably the corpus callosum. This anterior cerebral artery syndrome was characterized by right hemiparesis with predominant crural involvement, unilateral left-sided "disconnection" agraphia, and left unilateral "disconnection" tactile naming deficit. To our knowledge, this is the first case in the literature of the anterior cerebral artery syndrome in which unilateral leftsided apraxia was not associated with agraphia. The case is also the first in which Kanji-Kana dissociation of an aphasic nature has been reported as a feature of isolated left agraphia.

Agraphia↗
PubMed1992

Agraphia in dementia of the Alzheimer type.

This study describes graphic errors made in writing a simple sentence in 368 healthy older adults and individuals in different stages of dementia of the Alzheimer type. Errors of agraphia were present in both healthy and demented people and, in general, increased with the severity of dementia. The errors of agraphia were not correlated with measures of aphasia or psychometric measures of language and motor performance. Writing skill may represent procedural memory, and agraphia errors indicate alterations in long-term memory in dementia of the Alzheimer type.

Aged↗
PubMed2002

Phonological agraphia after superior temporal gyrus infarction.

BACKGROUND: Phonological agraphia refers to a condition in which the ability to write nonwords to dictation is impaired, while writing words to dictation is preserved, as is oral repetition of the words and nonwords. This condition has been regarded as reflecting a disconnection within the phonological writing system, and previous neurolinguistic correlations suggested that the anterior-inferior supramarginal gyrus was a crucial link within the system. SETTING: A neurology department of a university hospital. PATIENT: A 51-year-old right-handed man presented with speech disturbances. On initial evaluation of his language, his deficit was consistent with that of conduction aphasia, which improved rapidly to an apparently normal level. A subsequent detailed examination of oral and written repetition of words and nonwords revealed a rather selective form of phonological agraphia. A magnetic resonance imaging scan of his brain showed a focal ischemic lesion at the left posterior superior temporal gyrus and at the underlying white matter. CONCLUSIONS: In contrast to most previously described patients, this patient showed a selective impairment of phonological agraphia in association with a focal infarction restricted to the left posterior superior temporal gyrus, suggesting that this region of the brain is an important node within a wider network of areas that subserve the phonological route for writing.

Agraphia↗
PubMed1998

Effects of unilateral spatial neglect on spatial agraphia of kana and kanji letters.

Left unilateral spatial neglect (USN) and spatial agraphia are both caused by right hemisphere damage. However, effects of USN on spatial agraphia have not been fully investigated. This study examined performances of patients with or without neglect and normals on single letter writing, using Japanese unique writing systems, kana (phonogram) and kanji (ideogram). Our patients exhibited agraphia of kanji, but not of kana. However, accuracy of writing was not associated to neglect severity, and errors for writing to dictation occurred either on the left or right side of kanji. Right frontal damage seemed to be related to the genesis of duplication or omission errors of repeated elements. Effect of USN was limited to spatial arrangement of letters and copying performance.

Aged↗
PubMed1984

Multiple component agraphia in a patient with atypical cerebral dominance: an error analysis.

A 52-year-old man with atypical cerebral dominance (left-handed for writing but mixed handedness for other tasks) suffered an extensive right hemisphere stroke, resulting in a combination of deficits that has not been previously reported. There were profound visual constructive and visual perceptual disturbances and a spatial agraphia, which were consistent with a nondominant hemisphere lesion. There was also a severe apraxic agraphia, which is typically associated with a dominant hemisphere lesion, but no other signs of dominant hemisphere dysfunction such as linguistic disturbance or limb-motor apraxia were present. This case serves to highlight the functional and anatomical relationship between handwriting and other forms of praxis; the various sources of error in letter formation; the need to be specific in labeling and describing agraphias ; and the role of a detailed analysis of writing errors in delineating the neuropsychological processes involved in handwriting.

Agraphia↗
PubMed1988

Letter imagery deficits in a case of pure apraxic agraphia.

Pure apraxic agraphia is a condition in which motor writing is impaired but limb praxis and nonmotor writing (typing, anagram letters) are preserved. This condition is believed to result from disruption of a parietal lobe graphemic area which generates grapheme representations used to program motor-writing patterns. We report a single case of pure apraxic agraphia in which defective letter imagery was evident. Results of writing and imagery evaluations suggest that the graphemic area may be responsible for generating letter images. In this respect, clinical evaluation of letter imagery abilities in cases of apraxic agraphia may be useful in identifying subtypes of the disorder resulting in a better understanding of the neuropsychological process involved in writing.

Agraphia↗
PubMed1989

Written spelling agraphia.

When a disorder of single word writing is seen in conjunction with preserved oral spelling and intact written grapheme formation ("written spelling agraphia"), the deficit may be presumed to lie somewhere between letter choice and written motor output. Two potential deficits are considered: (1) visual letter codes are not activated properly and (2) the information contained within properly activated visual letter codes fails to reach intact graphic motor patterns. Two patients with written spelling agraphia were each given a series of tests aimed at distinguishing between the two possibilities. Results suggest that the written spelling agraphia seen in these two patients arises from different underlying deficits. The results are discussed in terms of the patients' CT scan lesion sites, which were markedly different.

Agraphia↗
PubMed1992

Lesion localization of phonological agraphia.

Phonological agraphia is a neurolinguistically specific profile of spelling impairment. It is characterized by an impairment in spelling pronounceable pseudowords ('sild') and by an impairment in spelling real words related to their familiarity, length, and often, part of speech (Shallice, 1981; Roeltgen, 1985; Bub & Chertkow, 1988). We report two cases of phonological agraphia, each with a different lesion profile. Analysis of the small number of published cases that include lesion data, plus our own cases, suggests that phonological agraphia can be produced by lesions in a wide range of perisylvian cortical regions that have in common some role in central phonological processes.

Agraphia↗