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PubMed1989

Lexical agraphia in Alzheimer's disease.

We studied spelling in 11 patients with senile dementia of the Alzheimer type (SDAT), and their performance was contrasted with that of normal controls. A consistent and specific pattern of linguistic agraphia was identified in the group with SDAT. Although patients with SDAT spelled regular words and nonwords as well as controls, they performed significantly worse when they spelled irregular words. These findings indicated an impairment of the lexical spelling system, consistent with the diagnosis of lexical agraphia. Our observations suggested a loss of word representations from the orthographic lexicon in SDAT and/or an inability to access these representations. However, phonological spelling (phoneme-grapheme conversion) was largely spared.

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PubMed1992

Lesion localization in apractic agraphia.

Apractic agraphia is an impairment in writing in which the actual orthographic production of letters and words is abnormal despite normal sensorimotor function, visual feedback, and word and letter knowledge. We report one case and review the limited clinicoanatomical literature. Analysis of available cases supports the hypothesis that apractic agraphia is one of several related clinical disorders that are due to the loss of spatially and kinesthetically modulated movements. It is produced by lesions in the superior parietal lobule, usually in the hemisphere dominant for language.

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PubMed1999

Marchiafava-Bignami disease: computed tomographic scan, 99mTc HMPAO-SPECT, and FLAIR MRI findings in a patient with subcortical aphasia, alexia, bilateral agraphia, and left-handed deficit of constructional ability.

OBJECTIVES: To report and discuss the neuropsychological deficits and neuroimaging findings in a patient with probable Marchiafava-Bignami disease. DESIGN AND METHOD: A right-handed woman with chronic alcoholism demonstrated mutism, impaired comprehension of spoken language, alexia, and right-handed agraphia. The syndrome of interhemispheric disconnection was manifested by left-handed deficit of constructional ability and agraphia. The patient underwent brain computed tomographic scans, technetium 99 hexylmethylpropylene amineoxime-single photon emission computed tomography, and magnetic resonance imaging (MRI) that also included fluid attenuated inversion recovery images. SETTING: Clinical neurology department. RESULTS: The patient's symptoms were related to scattered lesions of the corpus callosum and to extensive symmetrical lesions of the centrum semiovale. Only the latter were detected by computed tomographic scans. Results of single photon emission computed tomography did not show areas of focal hypoperfusion. Results of fast spinecho MRI showed all lesions were hyperintense in T1-weighted images and hypointense in T2-weighted images. Fluid attenuated inversion recovery images revealed that periventricular lesions had a hypointense core surrounded by a hyperintense rim; callosal lesions were still hyperintense. CONCLUSIONS: We believe that our patient's symptoms are due to the discontinuous affection of the corpus callosum and to the bilateral cutting of the outflow from the cortex. The MRI findings may be interpreted as indicating central necrosis and peripheral demyelination of periventricular lesions and demyelination of the corpus callosum. The combined use of fast spin echo and fluid attenuated inversion recovery MRI reproduced with more accuracy than fast spin echo MRI alone some features of Marchiafava-Bignami disease known from observations at autopsy.

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PubMed1983

Pure "aphasic" agraphia due to damage of the left superior parietal lobule.

A case of pure agraphia, due to an ischaemic lesion of the left superior parietal lobule, is reported. The neuropsychological analysis of writing performances suggests an aphasic nature of this patient's pure agraphia. The authors discuss the role played by diffuse and/or localized brain lesions in writing function, emphasizing that the left superior parietal lobule in man may be crucial for the sensorimotor linguistic integration needed for writing.

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PubMed1993

Acquired agraphia caused by focal brain damage.

Motor and linguistic aspects of writing were evaluated in 31 subjects with focal damage in 1 of 3 regions of the left hemisphere: (1) dorsolateral frontal lobe sparing primary motor cortex (group FL), (2) parietal lobe (group PL), or (3) temporal lobe (group TL). A standard procedure was used to evaluate writing for grapheme formation, spatial arrangement, spelling, word selection, grammar, and perseveration. It was predicted that agraphia would be observed in all 3 groups, and that the most severe impairments would be associated with frontal lobe damage, particularly in aspects of writing dependent on sequencing (grapheme formation, spelling, and grammar). It was found that agraphia was common in all groups, particularly in the acute epoch, and that all groups showed considerable recovery of writing by the chronic epoch. Few differences were found between groups. However, the FL group was impaired on spelling and grammar relative to the PL group in the acute epoch and impaired on grammar relative to the TL group in the chronic epoch. The findings are consistent with the notion that writing relies on a distributed neuroanatomical network, which acts in concert to link fragments of visuomotor activity with component linguistic elements.

Adult↗
PubMed1982

Mechanisms of reading and spelling in a case of alexia without agraphia.

In the clinical syndrome of alexia without agraphia, reading is greatly disturbed while writing and spelling remain relatively intact. The most commonly accepted explanation of this pattern of findings is that the center for written language interpretation remains intact, but has become inaccessible to visual input. This paper examines the nature of the intact written language center with respect to specific mechanisms of reading and spelling in a patient presenting with the major components of alexia without agraphia. It is concluded that the dissociation between reading and writing performance found in this patient reflects the existence of separate and distinct mechanisms for reading and spelling.

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PubMed1994

Transcortical alexia with agraphia following a right temporo-occipital hematoma in a right-handed patient.

We describe the case of a 51-year-old right-handed man who was affected by a transcortical alexia with agraphia and aphasia. Transcortical alexia produces errors in both reading and writing while copying is preserved. The patient had a severe alexia and was unable to read letters, words or sentences. Language examination showed mild aphasia with reduced fluency, intermittent paraphasia but a good comprehension and a normal repetition. Spontaneously and from dictation, writing was impaired by an agraphic jargon, but copying was excellent even though the patient was unable to read his own written production. There was no visual agnosia nor hemianopia. CT scan and MRI of the brain showed that there was a single right temporo-occipital hemorrhage but no lesion in the left hemisphere. Following surgical evacuation of the hematoma, the patient improved. One month after onset, his language was quite intact and reading was possible. We hypothesize that this particular syndrome was the result of a double disconnection: alexia would result from a disconnection of the right angular gyrus and the occipital associative areas by a subangular lesion; agraphia would result from a disconnection of the right angular gyrus and the semantic store, probably located in the right hemisphere.

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PubMed1983

Side differences in writing to dictation of aphasics with agraphia: a Graphic Disconnection Syndrome.

The performance of five aphasics with agraphia and right hemiplegia showing side differences in writing to dictation is reported on. It was found that writing with the paralyzed arm, supported by a writing aid, was better than writing with the left hand. In a control group of aphasics with agraphia, but without hemiplegia, such side differences were not found. The conclusion is drawn that in aphasia with hemiplegia the lesions intersect the path between the graphic region of the dominant hemisphere and the corpus callosum. Therefore the observed syndrome is termed "Graphic Disconnection Syndrome."

Adult↗
PubMed1987

Isolated lexical agraphia in a right-handed patient with a posterior lesion of the right cerebral hemisphere.

Lexical agraphia is thought to result from impairment of the lexical spelling system and is characterized by better spelling of nonwords and regularly spelled words than irregularly spelled words. Previous reports have suggested a localization of this syndrome in the region of the left posterior-superior angular gyrus and parietal-occipital lobule, sparing the supramarginal gyrus. We describe a right-handed man who after open-heart surgery displayed lexical agraphia without aphasia, alexia, apraxia, or Gerstmann's syndrome. Computed tomography disclosed a lesion not on the left but on the right in the posterior parietal-occipital region.

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PubMed1988

Pure agraphia and Gerstmann's syndrome as a visuospatial-language dissociation: an experimental case study.

A right-handed man suffered a left parieto-occipital cerebral infarction, causing agraphia with Gerstmann's syndrome but without major aphasia, alexia, or apraxia. Oral spelling was superior to written spelling. Experiments were performed involving (1) analysis of errors in writing, (2) tasks of visual imagery, and (3) identifying letters drawn without leaving a visual trace. The results suggest that the agraphia and Gerstmann's syndrome are due to a dissociation of language skills and visuospatial skills caused by a dominant parieto-occipital lesion.

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PubMed2000

Dissociation between distal and proximal left limb agraphia and agraphesthesia in a patient with a callosal disconnection syndrome.

A few neuropsychological studies have suggested the existence of bilateral hemispheric representations for the proximal parts of the limbs in humans. We report the case of a patient who presented with a callosal disconnection syndrome, which at a later stage of disease became restricted to left agraphia, left agraphesthesia and left auditory extinction. The anomic character of the agraphesthesia was demonstrated. Tactile naming was normal, which allows us to conclude that separate callosal pathways related to the left language areas transmit information for graphesthesia and tactile naming. Agraphia and agraphesthesia were not observed when the proximal part of the left upper limb was utilized. These observations support the conclusion that writing and graphesthesia with the proximal part of the limb can be mediated by the ipsilateral cortex.

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PubMed1979

Recovery from alexia without agraphia: report of an autopsy.

The patient is a 58-year-old Japanese teacher of German literature who suffered twice from cerebrovascular accidents, showing alexia without agraphia. Pathological examination showed an old infarct in the posterior two-thirds of the fusiform and almost the whole lingual gyrus, involving the posterior border of the parahippocampal gyrus in the left hemisphere. The left cuneus and the calcarine cortex were preserved. There was degeneration of the lower third of the splenium of the corpus callosum, extending to its occipital radiation and tapetum on both sides. Comparing clinico-pathological findings of the 31 known autopsy cases, it was proposed that the lesion of the left spleno-lingual system produces alexia without agraphia but it may ameliorate. In addition, when spleno-cuneate system is also involved alexia becomes persistent and it may accompany object agnosia or optic aphasia.

Agraphia↗
PubMed1981

Phonological agraphia and the lexical route in writing.

A new agraphia syndrome is described in which the patient can write certain classes of words virtually perfectly but is very poor at writing non-words. It is shown that this difficulty cannot be explained by perceptual or memory problems. A number of aspects of the syndrome are shown to correspond to those of phonological alexia within the acquired dyslexias. It thus appears that agraphia syndromes can be analysed by methods analogous to those recently developed for the study of the acquired dyslexias.

Agraphia↗
PubMed1979

Pure agraphia: a discrete form of aphasia.

A 62 year old, right handed man developed a pure agraphia as the result of a left temporal lobe stroke. Isolated writing disturbances persisted for seven months until he had a second cerebrovascular accident resulting in total aphasia and right hemiplegia. A CAT scan obtained four months after the first episode showed a localised dilatation of the posterior portion of the left Sylvian cistern and patchy areas of low absorption in the left temporal lobe. The report supports suggestions that localised damage to the language area can produce a pure agraphia as the sole detectable disorder of language organisation.

Agraphia↗
PubMed1987

Alexia with agraphia of kanji (Japanese morphograms).

The case of the right-handed young Japanese woman with alexia with agraphia of kanji (the Japanese morphograms) due to a small circumscribed haematoma in the left posterior inferior temporal gyrus is described. Her chief complaint was the inability to read and write kanji. Detailed examination showed that her alexia with agraphia was much more predominant for kanji than kana (the Japanese syllabograms). These facts suggest that the processing of kanji and kana involves different intrahemispheric mechanisms.

Adult↗
PubMed1994

Naming difficulties in alexia with agraphia for kanji after a left posterior inferior temporal lesion.

The case is described of a patient with alexia and agraphia for kanji, and severe anomia after a subcortical haemorrhage in the left posterior inferior temporal area. Magnetic resonance imaging at four months after onset showed a lesion in the inferior temporal and fusiform gyri, extending from the temporo-occipital junction toward the anterior third of the temporal lobe. Comparison with other reported cases of alexia with agraphia and anomia made it clear that when accompanied by severe anomia, the lesions extended either forward to the anterior part of the middle temporal gyrus or medially to the parahippocampal gyrus. It is suggested that the disconnection of association fibres between the parahippocampal, fusiform, middle, and inferior temporal gyri, especially between the parahippocampal gyrus and the other temporal gyri, or the cortical damage to the posterior part of these gyri is essential for the production of anomia.

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PubMed1995

Agraphia and acalculia after a left prefrontal (F1, F2) infarction.

A patient presented with agraphia and acalculia associated with a left frontal (F1, F2) infarction. He made mainly phonological but also lexical errors in writing (syllabograms), but his ability to write kanji (morphograms) was relatively preserved. Although he could add and subtract numbers, he could neither multiply nor divide them because of a difficulty in retrieving the multiplication tables and calculation procedures. Positron emission tomography showed decreased cerebral blood flow and metabolism limited to the infarct site. These findings suggest that agraphia and acalculia may occur associated with a left prefrontal lesion, and that the retrieval of arithmetic processes is modality specific.

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PubMed1999

Pure apraxic agraphia with abnormal writing stroke sequences: report of a Japanese patient with a left superior parietal haemorrhage.

A 67 year old Japanese male patient had pure agraphia after a haemorrhage in the left superior parietal lobule. He developed difficulty in letter formation but showed no linguistic errors, consistent with the criteria of apraxic agraphia. He manifested a selective disorder of sequencing writing strokes, although he was able to orally state the correct sequences. The patient's complete recovery after 1 month, without new learning, showed that he had manifested a selective disorder of writing stroke sequences. These findings indicate that the final stage of the execution of writing according to acquired sequential memory shown as a stroke sequence can be selectively disturbed, and should be considered to be distinct from the ability of character imagery and the knowledge of the writing stroke sequence itself. This case also indicates that the left superior parietal lobule plays an important part in the execution of writing.

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