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Reuter L, Carvalho G, Reuter A, Caldeira P. Reading and writing from right to left after anterior cerebral artery stroke. Dement Neuropsychol 2024; 18:e20230044. [PMID: 38628560 PMCID: PMC11019718 DOI: 10.1590/1980-5764-dn-2023-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 04/19/2024] Open
Abstract
This is the case report of a woman who started to write and read from right to left after anterior cerebral artery stroke, affecting the left supplementary motor area. No cases were found in the literature with exactly the same characteristics. She has been able to read and write faster after rehabilitation approach at Sarah Network of Rehabilitation Hospitals, in the Belo Horizonte city unit, Brazil, despite the maintenance of the inversion. She returned to her previous activities in an adaptive way. It was discussed how the dysfunction in this cerebral area and its connections may disturb the reading strategy and direction.
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Affiliation(s)
- Lílian Reuter
- Rede Sarah de Hospitais de Reabilitação, Belo Horizonte, MG, Brazil
| | | | - Alex Reuter
- Rede Sarah de Hospitais de Reabilitação, Belo Horizonte, MG, Brazil
| | - Paula Caldeira
- Rede Sarah de Hospitais de Reabilitação, Belo Horizonte, MG, Brazil
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Tsunoda S, Inoue T, Takeuchi N, Shinkai T, Segawa M, Akabane A. Two adult patients with moyamoya disease presenting with alexia with agraphia limited to kanji: can revascularization improve characteristic symptoms? Acta Neurochir (Wien) 2023; 165:625-30. [PMID: 36562875 DOI: 10.1007/s00701-022-05460-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
Patients with moyamoya disease (MMD) may exhibit higher brain dysfunction due to hypoperfusion, which may be ameliorated by revascularization. However, few studies have examined the relationship between cerebral perfusion and language function or the ameliorating effect of revascularization on language dysfunction. We present two cases with MMD who presented with alexia with agraphia, specifically for Japanese kanji. The patients had impaired perfusion in the left inferior temporal and lateral occipital lobes. Following superficial temporal artery-middle cerebral artery bypass, the symptoms improved dramatically. Thus, correction of hypoperfusion may be effective even in adult patients with MMD presenting with language dysfunction.
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Fernandes CP, Montalvo G, Caligiuri M, Pertsinakis M, Guimarães J. Handwriting Changes in Alzheimer's Disease: A Systematic Review. J Alzheimers Dis 2023; 96:1-11. [PMID: 37718808 DOI: 10.3233/jad-230438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Handwriting is a complex process involving fine motor skills, kinesthetic components, and several cognitive domains, often impaired by Alzheimer's disease (AD). OBJECTIVE Provide a systematic review of handwriting changes in AD, highlighting the effects on motor, visuospatial and linguistic features, and to identify new research topics. METHODS A search was conducted on PubMed, Scopus, and Web of Science to identify studies on AD and handwriting. The review followed PRISMA norms and analyzed 91 articles after screening and final selection. RESULTS Handwriting is impaired at all levels of the motor-cognitive hierarchy in AD, particularly in text, with higher preservation of signatures. Visuospatial and linguistic features were more affected. Established findings for motor features included higher variability in AD signatures, higher in-air/on-surface time ratio and longer duration in text, longer start time/reaction time, and lower fluency. There were conflicting findings for pressure and velocity in motor features, as well as size, legibility, and pen lifts in general features. For linguistic features, findings were contradictory for error patterns, as well as the association between agraphia and severity of cognitive deficits. CONCLUSIONS Further re-evaluation studies are needed to clarify the divergent results on motor, general, and linguistic features. There is also a lack of research on the influence of AD on signatures and the effect of AD variants on handwriting. Such research would have an impact on clinical management (e.g., for early detection and patient follow-up using handwriting tasks), or forensic examination aimed at signatory identification.
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Affiliation(s)
- Carina Pereira Fernandes
- NCForenses Institute, Porto, Portugal
- Instituto Universitario de Investigación en Ciencias Policiales (IUICP), Universidad de Alcalá, Alcalá de Henares, Spain
| | - Gemma Montalvo
- Instituto Universitario de Investigación en Ciencias Policiales (IUICP), Universidad de Alcalá, Alcalá de Henares, Spain
- Universidad de Alcalá, Departamento de Química Analítica, Química Física e Ingeniería Química, Alcalá de Henares, Spain
| | - Michael Caligiuri
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Michael Pertsinakis
- Ingeniería Química, Alcalá de Henares, Spain
- City Unity College, Athens, Greece
| | - Joana Guimarães
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal
- MedInUP - Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
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Abstract
INTRODUCTION Capecitabine is a pre-metabolite of 5-fluorouracil and is used as a chemotherapeutic agent. Among the common side effects of capecitabine, there are gastrointestinal side effects including nausea, vomiting, and diarrhea, and dermatological side effects including hand-foot syndrome and skin pigmentation change. However, neurological side effects of capecitabine are very rare. We describe herein a patient who developed neurological side effects in the form of agraphia and dysarthria on the 7th day of capecitabine treatment. CASE REPORT A 34-year-old male patient, who was being followed up with the diagnosis of colon cancer, presented with speech and writing disorder that developed while under capecitabine treatment. Dysarthria and agraphia were detected in his neurological examination. Diffusion-weighted magnetic resonance imaging (MRI) revealed acute diffusion restriction in the splenium of the corpus callosum and at the level of the bilateral centrum semiovale. Brain MRI revealed symmetrical T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) signal increases at the right temporoparietal medial, corpus callosum level, and bilateral white matter level. MANAGEMENT & OUTCOME The capecitabine treatment was terminated, and methylprednisolone treatment was administered and plasmapheresis procedure was carried out. Subsequently, significant improvement was observed in the clinical findings and neuroimaging. DISCUSSION Capecitabine is used as an oral agent; thus, it provides ease of use. Neurological side effects associated with the use of capecitabine reportedly occur very rarely. The findings of this case demonstrated that leukoencephalopathy can be seen during the use of capecitabine, imaging results are very important in the diagnosis of leukoencephalopathy, and improvement can be achieved with the termination of the capecitabine treatment.
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Affiliation(s)
- Dilek Iscan
- Faculty of Medicine, Department of Neurology, 52989Niğde Ömer Halisdemir University Training and Research Hospital, Nigde, Turkey
| | - Rumeysa Tolay
- Faculty of Medicine, Department of Neurology, 63988Cukurova University, Adana, Turkey
| | - Ertugrul Bayram
- Faculty of Medicine, Department of Medical Oncology, 63988Cukurova University, Adana, Turkey
| | - Turgay Demir
- Faculty of Medicine, Department of Neurology, 63988Cukurova University, Adana, Turkey
| | - Sebnem Bicakci
- Faculty of Medicine, Department of Neurology, 63988Cukurova University, Adana, Turkey
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Abstract
This chapter gives a broad overview of the description and theorizing of a wide range of language disorders resulting from brain damage, commonly classified under the umbrella term "aphasia." It covers works written in Antiquity up to the 20th century. Moreover, it looks at disturbances in various language modalities such as speech, language comprehension, reading, writing, and sign language. In addition, also forms of the more recently discovered primary progressive aphasia are discussed. Finally, important developments in the history of assessment and rehabilitation of language disorders are described. To properly characterize disorders of language, these developments are discussed from the perspectives of neurology, psychology, and linguistics.
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Affiliation(s)
- Paul Eling
- Department of Psychology, Radboud University, Nijmegen, The Netherlands.
| | - Harry Whitaker
- Independent Scholar, Retired University Professor, Minnesota, MN, United States
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Abstract
BACKGROUND Agraphia is a typical feature in the clinical course of Alzheimer's disease (AD). OBJECTIVE Assess the differences between AD and normal aging as regards kinematographic features of handwriting and elucidate writing deficits in AD. METHODS The study included 23 patients with AD (78.09 years/SD = 7.12; MMSE 21.39/SD = 3.61) and 34 healthy controls (75.56 years/SD = 5.85; MMSE 29.06/SD = 0.78). Both groups performed alphabetical and non-alphabetical writing tasks. The kinematographic assessment included the average number of inversions per stroke (NIV; number of peaks in the velocity profile in a single up or down stroke), percentage of automated segments, frequency (average number of strokes per second), writing pressure, and writing velocity on paper. RESULTS A total of 14 patients showed overt writing difficulties reflected by omissions or substitutions of letters. AD patients showed less automated movements (as measured by NIV), lower writing velocity, and lower frequency of up-and-down strokes in non-alphabetical as well as in alphabetical writing. In the patient group, Spearman correlation analysis between overt writing performance and NIV was significant. That means patients who had less errors in writing a sentence showed a higher automaticity in handwriting. The correctness of alphabetical writing and some kinematographic measures in writing non-alphabetical material reached excellent diagnostic values in ROC analyses. There was no difference in the application of pressure on the pen between patients and controls. CONCLUSION Writing disorders are multi-componential in AD and not strictly limited to one processing level. The slow and poorly automated execution of motor programs is not bound to alphabetical material.
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Affiliation(s)
- Margarete Delazer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Gonzalez R, Rojas M, Ardila A. Alexia and agraphia in Spanish. Int J Lang Commun Disord 2020; 55:875-883. [PMID: 32735061 DOI: 10.1111/1460-6984.12566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Every language has certain specific idiosyncrasies in its writing system. Cross-linguistic analyses of alexias and agraphias are fundamental to understand commonalities and differences in the brain organization of written language. Few reports of alexias and agraphias in the Spanish language are currently available. AIMS To analyse the clinical manifestations of alexias and agraphias in Spanish, and the effect of demographic variables. METHODS & PROCEDURES Spanish versions of the Western Aphasia Battery (WAB) and Boston Diagnostic Aphasia Examination (BDAE) were used for language assessment. Lesion localization was obtained by using computed axial tomography and magnetic resonance imaging. The final sample included 200 patients: 195 (97.5%) right-handed and five (2.5%) left-handed; 119 men and 81 women with a mean age of 57.37 years (SD = 15.56), education of 13.52 years (SD = 4.08), and mean time post-onset of 6.58 months (SD = 12.94). Using the WAB, four quotients were calculated: aphasia quotient (AQ), reading-writing quotient (RWQ), language quotient (LQ) and cortical quotient (CQ). OUTCOMES & RESULTS The types of aphasia were: global = 11 patients (5.5%), Broca = 31 (15.5%), Wernicke = 30 (15.0%), conduction = 22 (11.0%), transcortical sensory = 17 (8.5%), transcortical motor = 3 (1.5%), amnesic or anomic = 54 (27.0%) and mixed non-fluent = 32 (16.0%). The degree of oral and written language impairment differed across the various aphasia types. Most severe reading and writing difficulties were found in global, mixed non-fluent and transcortical motor aphasia; fewer difficulties were observed in amnesic, Broca and conduction aphasia. The severity of the written language impairments paralleled the severity of the oral language disturbances. Age negatively, while schooling positively, correlated with the scores in reading and writing tests. No effect of sex and time since onset was found. CONCLUSIONS & IMPLICATIONS In Spanish-speaking aphasia patients, difficulties in reading and writing are similar to oral language difficulties. This similarity of performance is mostly based on severity rather than the participants' patterns of errors. What this paper adds What is already known on the subject There is limited information about alexia and agraphia in Spanish. What this paper adds to existing knowledge An extensive study with a large sample of patients. What are the potential or actual clinical implications of this work? The study contributes to the clinical management of patients with reading and writing disturbances.
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Affiliation(s)
- Rafael Gonzalez
- Departamento de Neurología y Neurocirugía, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Macarena Rojas
- Departamento de Neurología y Neurocirugía, Hospital Clínico de la Universidad de Chile, Santiago, Chile
| | - Alfredo Ardila
- Institute of Linguistics and Intercultural Communication, Sechenov University, Moscow, Russia
- Psychology Doctoral Program, Albizu University, Miami, FL, USA
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Priftis K, Algeri L, Villella S, Spada MS. COVID-19 presenting with agraphia and conduction aphasia in a patient with left-hemisphere ischemic stroke. Neurol Sci 2020; 41:3381-3384. [PMID: 32989587 PMCID: PMC7521766 DOI: 10.1007/s10072-020-04768-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/24/2020] [Indexed: 11/27/2022]
Abstract
COVID-19 following infection by SARS-CoV-2 can affect the brain causing confusion, depression, and dementia-like signs. Nonetheless, the presence of more specific neuropsychological signs because of COVID-19 remains unexplored. We report on LA, a patient who was affected by a left-hemisphere ischemic stroke, probably because of SARS-CoV-2. The patient showed a highly specific neuropsychological profile characterized by severe agraphia and some signs of conduction aphasia. All other cognitive and sensorimotor functions remained intact. We sustain that specific neuropsychological signs can be observed in patients with COVID-19. Therefore, in-depth and comprehensive neuropsychological assessment should be included to better explore and qualify the neuropsychological consequences of COVID-19. This is a new challenge for diagnosis and rehabilitation, with important consequences for the involved neuropsychological services.
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Affiliation(s)
- Konstantinos Priftis
- Department of General Psychology, University of Padua, Padua, Italy. .,Human Inspired Technology Center, University of Padua, Padua, Italy.
| | - Lorella Algeri
- UOC Psychology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Stella Villella
- UOC Special Rehabilitation, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Julayanont P, Burks DW, Heilman KM. Proactive interference apraxic agraphia: a writing and drawing disorder associated with corticobasal syndrome. Neurocase 2020; 26:125-130. [PMID: 32323627 DOI: 10.1080/13554794.2020.1757719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Proactive interference is when a previously performed task impairs performance on a current task. It is often associated with memory tasks and has not been reported to interfere with writing or drawing. We evaluated a left-handed man diagnosed with corticobasal syndrome who had a two-year history of progressive agraphia. On the sentence writing and clock drawing tasks, he initially wrote letters and numbers correctly but revealed an increase of movement errors as the tasks progressed. We propose the term "proactive interference apraxic agraphia" for this novel disorder. Prefrontal dysfunction may cause an impairment in disengaging from previously activated motor programs.
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Affiliation(s)
- Parunyou Julayanont
- Division of Cognitive and Behavioral Neurology, Department of Neurology, University of Florida College of Medicine , Gainesville, USA.,Behavioral and Cognitive Neurology Clinic, Department of Neurology, Texas Tech University Health Sciences Center, School of Medicine , Lubbock, USA
| | - David W Burks
- Division of Cognitive and Behavioral Neurology, Department of Neurology, University of Florida College of Medicine , Gainesville, USA.,Department of Neurology, Malcom Randall Veterans Affairs Medical Center , Gainesville, USA
| | - Kenneth M Heilman
- Division of Cognitive and Behavioral Neurology, Department of Neurology, University of Florida College of Medicine , Gainesville, USA.,Department of Neurology, Malcom Randall Veterans Affairs Medical Center , Gainesville, USA
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Miyakawa Y, Fuchigami T, Aoki M, Mine Y, Suzuki J, Urakami T, Takahashi S. Agraphia with reversible splenial corpus callosum lesion caused by hypoglycemia. Brain Dev 2018; 40:592-595. [PMID: 29606344 DOI: 10.1016/j.braindev.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/24/2018] [Accepted: 03/14/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Neurological manifestations caused by hypoglycemia range from reversible focal deficits and transient encephalopathy to irreversible coma or death. Recently, high signal intensity lesions in the splenium of the corpus callosum on diffusion-weighted magnetic resonance imaging were reported in adults experiencing hypoglycemia. However, patients presenting with agraphia are rare. SUBJECT AND METHODS We examined a 17-year-old left-handed female patient with type 1 diabetes who exhibited transient left agraphia with a reversible splenium lesion of the corpus callosum on diffusion-weighted imaging caused by hypoglycemia, which was improved with blood glucose management alone. CONCLUSION This rare case indicates that agraphia, a sign of callosal disconnection syndrome, can result from a reversible splenial lesion of the corpus callosum caused by hypoglycemia.
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Affiliation(s)
- Yukari Miyakawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Tatsuo Fuchigami
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.
| | - Masako Aoki
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Yusuke Mine
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Junichi Suzuki
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Tatsuhiko Urakami
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Shori Takahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
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Takahashi N, Kawamura M, Kobayashi Y. A Case of Nonalcoholic Marchiafava-Bignami Disease with Left-Right Differential Agraphia of Chinese Characters. Case Rep Neurol 2018; 10:232-241. [PMID: 30283321 PMCID: PMC6167702 DOI: 10.1159/000492528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/27/2018] [Indexed: 11/25/2022] Open
Abstract
We report a 68-year-old right-handed female who was admitted to our hospital complaining chiefly of incontinence and decreased activity. Her brain images showed characteristics of Marchiafava-Bignami disease, such as symmetrical abnormal signals localized in the corpus callosum. The patient had no drinking habits. Her past medical history included total gastric resection to treat gastric cancer. On hospital admission she was markedly underweight. This appeared to be a rare case of Marchiafava-Bignami disease not attributable to heavy drinking and occurring in a state of malnutrition. Evaluation of callosal dissociation symptoms produced findings indicative of such symptoms. She showed a marked difficulty in writing dictated single words and short sentences in Japanese alphabetic characters, especially with her left hand. In contrast, writing dictated words in Chinese characters (also used in written Japanese) was affected in both hands, with different types of dysgraphia seen in the right and left hands. The agraphia in the left hand seen in this patient appears to have occurred as a result of the language faculty of the left hemisphere failing to be transmitted to the right brain, while agraphia in the right hand may have occurred as a result of spatial processing information in the right hemisphere failing to be transmitted to the left hemisphere.
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Affiliation(s)
- Nobuhiro Takahashi
- Department of Rehabilitation, Fukui College of Health Sciences, Fukui City, Japan
| | - Mimpei Kawamura
- Department of Rehabilitation, Fukui College of Health Sciences, Fukui City, Japan
| | - Yasutaka Kobayashi
- Department of Rehabilitation Medicine, Fukui General Hospital, Fukui City, Japan
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Baldo JV, Kacinik N, Ludy C, Paulraj S, Moncrief A, Piai V, Curran B, Turken A, Herron T, Dronkers NF. Voxel-based lesion analysis of brain regions underlying reading and writing. Neuropsychologia 2018; 115:51-59. [PMID: 29572061 DOI: 10.1016/j.neuropsychologia.2018.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 02/23/2018] [Accepted: 03/17/2018] [Indexed: 10/17/2022]
Abstract
The neural basis of reading and writing has been a source of inquiry as well as controversy in the neuroscience literature. Reading has been associated with both left posterior ventral temporal zones (termed the "visual word form area") as well as more dorsal zones, primarily in left parietal cortex. Writing has also been associated with left parietal cortex, as well as left sensorimotor cortex and prefrontal regions. Typically, the neural basis of reading and writing are examined in separate studies and/or rely on single case studies exhibiting specific deficits. Functional neuroimaging studies of reading and writing typically identify a large number of activated regions but do not necessarily identify the core, critical hubs. Last, due to constraints on the functional imaging environment, many previous studies have been limited to measuring the brain activity associated with single-word reading and writing, rather than sentence-level processing. In the current study, the brain correlates of reading and writing at both the single- and sentence-level were studied in a large sample of 111 individuals with a history of chronic stroke using voxel-based lesion symptom mapping (VLSM). VLSM provides a whole-brain, voxel-by-voxel statistical analysis of the role of distinct regions in a particular behavior by comparing performance of individuals with and without a lesion at every voxel. Rather than comparing individual cases or small groups with particular behavioral dissociations in reading and writing, VLSM allowed us to analyze data from a large, well-characterized sample of stroke patients exhibiting a wide range of reading and writing impairments. The VLSM analyses revealed that reading was associated with a critical left inferior temporo-occipital focus, while writing was primarily associated with the left supramarginal gyrus. Separate VLSM analyses of single-word versus sentence-level reading showed that sentence-level reading was uniquely associated with anterior to mid-portions of the middle and superior temporal gyri. Both single-word and sentence-level writing overlapped to a great extent in the left supramarginal gyrus, but sentence-level writing was associated with additional underlying white matter pathways such as the internal capsule. These findings suggest that critical aspects of reading and writing processes diverge, with reading relying critically on the ventral visual recognition stream and writing relying on a dorsal visuo-spatial-motor stream.
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Affiliation(s)
- Juliana V Baldo
- VA Northern California Health Care System, 150 Muir Rd. (126R), Martinez, CA 94553, USA.
| | | | - Carl Ludy
- VA Northern California Health Care System, 150 Muir Rd. (126R), Martinez, CA 94553, USA
| | - Selvi Paulraj
- VA Northern California Health Care System, 150 Muir Rd. (126R), Martinez, CA 94553, USA; Palo Alto University, USA
| | - Amber Moncrief
- VA Northern California Health Care System, 150 Muir Rd. (126R), Martinez, CA 94553, USA
| | - Vitória Piai
- Radboud University, Donders Centre for Brain, Cognition and Behaviour, The Netherlands; Radboudumc, Department of Medical Psychology, The Netherlands
| | - Brian Curran
- VA Northern California Health Care System, 150 Muir Rd. (126R), Martinez, CA 94553, USA
| | - And Turken
- VA Northern California Health Care System, 150 Muir Rd. (126R), Martinez, CA 94553, USA
| | - Tim Herron
- VA Northern California Health Care System, 150 Muir Rd. (126R), Martinez, CA 94553, USA
| | - Nina F Dronkers
- VA Northern California Health Care System, 150 Muir Rd. (126R), Martinez, CA 94553, USA; University of California, Davis, USA
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Abstract
Apraxic agraphia can be caused by left hemispheric cerebral lesions in the area that contains the spatial representations of the movements required to write, from a lesion in, or connections to, the frontal premotor cortex that converts these spatial representations to motor programs (Exner's area). A right-handed woman with Marchiafava Bignami disease and lesions of the genu and splenium of her corpus callosum had apraxic agraphia without ideomotor apraxia of her left. A disconnection of Exner's area in the left hemisphere from the right hemisphere's premotor and motor areas may have led to her inability to write with her left hand.
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Affiliation(s)
- T Kesayan
- a Department of Neurology , University of South Florida Morsani College of Medicine , Tampa , FL , USA.,b Department of Neurology , James A. Haley Veteran's Affairs Hospital , Tampa , FL , USA
| | - K M Heilman
- c Neurology Service and GRECC , Malcom Randall Veterans Affairs Medical Center , Gainesville , FL , USA.,d Department of Neurology , University of Florida College of Medicine , Gainesville , FL , USA
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Bianucci R, Marías Franco F, Appenzeller O. El Greco depicted his own neurological disabilities. J Neurol Sci 2017; 375:478. [PMID: 28094010 DOI: 10.1016/j.jns.2017.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Affiliation(s)
- R Bianucci
- Department of Public Health and Paediatric Sciences, Legal Medicine Section, University of Turin, Corso Galileo Galilei, 22, 10126 Turin, Italy; UMR 7268, Laboratoire d'Anthropologie bio-culturelle, Droit, Etique & Santé (Adés), Faculté de Médecine de Marseille, Secteur Nord Batiment A - CS80011 Bd Pierre Dramard, 13344 Marseille, Cedex 15, France.
| | - F Marías Franco
- Department of History and Theory of Art, Universidad Autónoma de Madrid, Ciudad Universitaria de Cantoblanco, 28049 Madrid, Spain
| | - O Appenzeller
- New Mexico Health Enhancement and Marathon Clinics Research Foundation, 361 Ridge Horne Dr. NE, Albuquerque, NM, USA; New Mexico Museum of Natural History and Science, 1801 Mountain Road NW, Albuquerque, NM, USA
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Bianucci R, Marías Franco F, Appenzeller O. Historical evidence supports El Greco's depiction of a neurological condition in his attributed self-portrait. J Neurol Sci 2017; 372:316-7. [PMID: 28017236 DOI: 10.1016/j.jns.2016.11.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/08/2016] [Accepted: 11/30/2016] [Indexed: 11/20/2022]
Abstract
Icono-diagnosis, the retrospective image-based diagnosis of pathologies, was applied to the canvas "Portrait of an Old Man" (1595-1600), an attributed self-portrait painted by El Greco. The presence of congenital enophthalmos, strabismus, probable amblyopia and signs of left neglect were found. We assume these sign may be consistent an ischemic event affecting the right middle cerebral artery supply territory. Historically, motor activity was not compromised and the painter was able to return to portraiture. Documental evidence indicates, that a few years later (1608), El Greco suffered another cerebrovascular event resulting in agraphia. The pictorial and historical evidence is consistent with multiple ischemic events resulting in progressive disabilities with fluctuating course characterized by temporary improvements and worsening before his death in 1614.
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Kobayashi Y, Yamauchi R. A Case of Anoxic Brain Injury Presenting with Agraphia of kanji in the Foreground. Case Rep Neurol 2017; 9:36-43. [PMID: 28611641 PMCID: PMC5465795 DOI: 10.1159/000458434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/26/2017] [Indexed: 11/28/2022] Open
Abstract
A 63-year-old woman was hospitalized for rehabilitation from the aftereffects of an anoxic brain injury. In addition to a general cognitive decline, agraphia of kana and kanji was noted at the time of admission, which had advanced to agraphia which is dominant in kanji at the time of hospital discharge. Brain magnetic resonance imaging revealed no stroke lesions, and brain perfusion scintigraphy found a decreased blood flow in the bilateral parietal lobes. We hereby report on this case because case reports on agraphia caused by anoxic brain injury are extremely rare.
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Affiliation(s)
- Yasutaka Kobayashi
- aDepartment of Rehabilitation Medicine, Fukui General Hospital, Fukui, Japan
| | - Risa Yamauchi
- bDepartment of Rehabilitation Medicine, Fukui General Clinic, Fukui, Japan
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17
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Abstract
Phonological alexia and agraphia are written language disorders characterised by disproportionate difficulty reading and spelling nonwords in comparison to real words. In phonological alexia, it has been shown that, despite relatively accurate reading of words in isolation, text-level reading deficits are often marked and persistent. Specifically, some individuals demonstrate difficulty reading functors and affixes in sentences, a profile referred to as phonological text alexia. In this paper, we demonstrate an analogous manifestation of the phonological impairment on text-level writing and suggest the term "phonological text agraphia". We examined four individuals with phonological alexia/agraphia who also showed disproportionate difficulty writing well-formed sentences in comparison to their grammatical competence in spoken utterances. Implementation of a phonological treatment protocol resulted in significantly improved sublexical phonology skills as well as improvements in grammatical accuracy of written narratives. These findings support the notion of a common phonological impairment underlying nonword reading/spelling deficits and sentence-level difficulties.
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Affiliation(s)
- Pélagie M Beeson
- a Department of Speech, Language, and Hearing Sciences , The University of Arizona , Tucson , AZ , USA.,b Department of Neurology , The University of Arizona , Tucson , AZ , USA
| | - Kindle Rising
- a Department of Speech, Language, and Hearing Sciences , The University of Arizona , Tucson , AZ , USA
| | - Andrew T DeMarco
- a Department of Speech, Language, and Hearing Sciences , The University of Arizona , Tucson , AZ , USA
| | - Taylor Howard Foley
- a Department of Speech, Language, and Hearing Sciences , The University of Arizona , Tucson , AZ , USA
| | - Steven Z Rapcsak
- a Department of Speech, Language, and Hearing Sciences , The University of Arizona , Tucson , AZ , USA.,b Department of Neurology , The University of Arizona , Tucson , AZ , USA.,c Southern Arizona Veteran's Health Care System , Tucson , AZ , USA
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Sitek EJ, Barczak A, Kluj-Kozłowska K, Kozłowski M, Barcikowska M, Sławek J. Is descriptive writing useful in the differential diagnosis of logopenic variant of primary progressive aphasia, Alzheimer's disease and mild cognitive impairment? Neurol Neurochir Pol 2015; 49:239-44. [PMID: 26188940 DOI: 10.1016/j.pjnns.2015.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
Abstract
Current classification of primary progressive aphasia (PPA) encompasses three variants: non-fluent (nfvPPA), semantic (svPPA) and logopenic (lvPPA). Previously lvPPA was regarded as aphasic form of Alzheimer's disease (AD). However, not all patients with lvPPA phenotype present with AD pathology. Despite abundant literature on differentiation of lvPPA from svPPA and nfvPPA, studies comparing lvPPA with AD and mild cognitive impairment (MCI) are scarce. This study aimed at analyzing written descriptive output in lvPPA, AD and MCI. Thirty-five patients participated in the study: 9 with lvPPA, 13 with AD and 13 with MCI. Most aspects of writing performance were comparable in three groups. However, letter insertion errors appeared in 44% patients with lvPPA, while they were absent in AD and MCI. Patients with lvPPA used more verbs than patients with AD. Writing profile may complement other neuropsychological assessment results in the differential diagnosis of lvPPA. Letter insertion errors and frequent verb use may raise a query of lvPPA.
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Affiliation(s)
- Emilia J Sitek
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdansk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland.
| | - Anna Barczak
- Neurology Department, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland
| | - Klaudia Kluj-Kozłowska
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdansk, Poland; Speech Therapy Department, Faculty of Languages, University of Gdansk, Gdansk, Poland
| | - Marcin Kozłowski
- Speech Therapy Department, Faculty of Languages, University of Gdansk, Gdansk, Poland; Neurological Rehabilitation Department, Specialist Hospital in Koscierzyna, Dzierzazno, Poland
| | - Maria Barcikowska
- Neurodegenerative Disorders Department, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
| | - Jarosław Sławek
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdansk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland
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Sitek EJ, Barczak A, Kluj-Kozłowska K, Kozłowski M, Narożańska E, Konkel A, Dąbrowska M, Barcikowska M, Sławek J. Writing in Richardson variant of progressive supranuclear palsy in comparison to progressive non-fluent aphasia. Neurol Neurochir Pol 2015; 49:217-22. [PMID: 26188937 DOI: 10.1016/j.pjnns.2015.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/24/2015] [Accepted: 05/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The overlap between progressive supranuclear palsy (PSP) and progressive non-fluent aphasia (PNFA) is being increasingly recognized. In this paper descriptive writing in patients with Richardson syndrome of progressive supranuclear palsy (PSP-RS) is compared to writing samples from patients with PNFA. METHODS Twenty-seven patients participated in the study: 17 with the clinical diagnosis of PSP-RS and 10 with PNFA. Untimed written picture description was administered during neuropsychological assessment and subsequently scored by two raters blinded to the clinical diagnosis. Lexical and syntactic content, as well as writing errors (e.g. omission and perseverative errors) were analyzed. RESULTS In patients with PSP-RS both letter and diacritic mark omission errors were very frequent. Micrographia was present in 8 cases (47%) in PSP-RS group and in one case (10%) with PNFA. Perseverative errors did not differentiate between the groups. CONCLUSIONS As omission errors predominate in writing of patients with PSP-RS, writing seems to be compromised mainly because of oculomotor deficits, that may alter visual feedback while writing.
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Affiliation(s)
- Emilia J Sitek
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdansk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland.
| | - Anna Barczak
- Neurology Department, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
| | - Klaudia Kluj-Kozłowska
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdansk, Poland; Speech Therapy Chair, Faculty of Languages, University of Gdansk, Gdansk, Poland.
| | - Marcin Kozłowski
- Speech Therapy Chair, Faculty of Languages, University of Gdansk, Gdansk, Poland; Neurological Rehabilitation Department, Specialist Hospital in Koscierzyna, Dzierzazno, Poland.
| | - Ewa Narożańska
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdansk, Poland.
| | - Agnieszka Konkel
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdansk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland.
| | - Magda Dąbrowska
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdansk, Poland.
| | - Maria Barcikowska
- Neurodegenerative Disorders Department, Mossakowski Medical Research Center, Polish Academy of Sciences, Warsaw, Poland.
| | - Jarosław Sławek
- Neurology Department, St. Adalbert Hospital, Copernicus Podmiot Leczniczy Sp. z o.o., Gdansk, Poland; Department of Neurological and Psychiatric Nursing, Medical University of Gdansk, Gdansk, Poland.
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Jang DH, Kim MW, Park KH, Lee JW. Language-specific dysgraphia in Korean patients with right brain stroke: influence of unilateral spatial neglect. J Korean Med Sci 2015; 30:323-7. [PMID: 25729257 PMCID: PMC4330489 DOI: 10.3346/jkms.2015.30.3.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/16/2014] [Indexed: 11/20/2022] Open
Abstract
The purpose of the present study was to investigate the relationship between Korean language-specific dysgraphia and unilateral spatial neglect in 31 right brain stroke patients. All patients were tested for writing errors in spontaneous writing, dictation, and copying tests. The dysgraphia was classified into visuospatial omission, visuospatial destruction, syllabic tilting, stroke omission, stroke addition, and stroke tilting. Twenty-three (77.4%) of the 31 patients made dysgraphia and 18 (58.1%) demonstrated unilateral spatial neglect. The visuospatial omission was the most common dysgraphia followed by stroke addition and omission errors. The highest number of errors was made in the copying and the least was in the spontaneous writing test. Patients with unilateral spatial neglect made a significantly higher number of dysgraphia in the copying test than those without. We identified specific dysgraphia features such as a right side space omission and a vertical stroke addition in Korean right brain stroke patients. In conclusion, unilateral spatial neglect influences copy writing system of Korean language in patients with right brain stroke.
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Affiliation(s)
- Dae-Hyun Jang
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Min-Wook Kim
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Kyoung Ha Park
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Jae Woo Lee
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
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Lee M, Suh MK, Lee MH, Lee JS, Moon SY. Agraphia caused by acute right parietal infarction. J Clin Neurosci 2015; 22:758-60. [PMID: 25564267 DOI: 10.1016/j.jocn.2014.09.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 09/19/2014] [Accepted: 09/21/2014] [Indexed: 11/30/2022]
Abstract
Injury in the dominant language hemisphere typically leads to agraphia, however we report a patient with agraphia after injury to the right angular gyrus. A 71-year-old Korean woman presented with the complaint of an inability to write for the last 7 days. The patient had been illiterate for most of her life, but had started learning to write Hangul, the Korean alphabet, at a welfare center 3 years ago. On language screening she was unable to write although she could read, and other language functions showed no abnormalities. Brain MRI showed acute infarction in the right angular gyrus. Her writing patterns displayed features of surface agraphia, indicative of phoneme-to-grapheme conversion with phonetic writing of targets. Additionally, she manifested visual errors. A functional MRI indicated that her left hemisphere was language dominant. This patient experienced agraphia resulting from pure impairment of visuo-constructive function after acute infarction in the right angular gyrus.
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Affiliation(s)
- Manyong Lee
- Department of Neurology, Ajou University, School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon, Kyungki-do 443-721, Republic of Korea
| | - Mee Kyung Suh
- Department of Neurology, Samsung Medical Center, Seoul, Republic of Korea
| | - Myung Hyun Lee
- Department of Neurology, Ajou University, School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon, Kyungki-do 443-721, Republic of Korea
| | - Jin Soo Lee
- Department of Neurology, Ajou University, School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon, Kyungki-do 443-721, Republic of Korea
| | - So Young Moon
- Department of Neurology, Ajou University, School of Medicine, San 5, Woncheon-dong, Yeongtong-gu, Suwon, Kyungki-do 443-721, Republic of Korea.
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22
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Mariën P, Beaton A. The enigmatic linguistic cerebellum: clinical relevance and unanswered questions on nonmotor speech and language deficits in cerebellar disorders. Cerebellum Ataxias 2014; 1:12. [PMID: 26331036 PMCID: PMC4552409 DOI: 10.1186/2053-8871-1-12] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 06/18/2014] [Indexed: 11/10/2022]
Abstract
Clinical case descriptions and experimental evidence dating back to the early part of the 19th century from time to time documented a range of nonmotor cognitive and affective impairments following cerebellar pathology. However, a causal relationship between disruption of nonmotor cognitive and affective skills and cerebellar disease was dismissed for several decades and the classical view of the cerebellum as a mere coordinator of autonomic and somatic sensorimotor function prevailed for more than two centuries in behavioural neuroscience. The ignorance of early clinical evidence suggesting a much richer and complex role for the cerebellum than a pure sensorimotor one is remarkable given that in addition: 1) the cerebellum contains more neurons than the rest of the combined cerebral cortex and 2) no other structure has as many connections with other parts of the brain as the cerebellum. During the past decades, the long-standing view of the cerebellum as pure coordinator of sensorimotor function has been substantially modified. From the late 1970s onwards, major advances were made in elucidating the many functional neuroanatomical connections of the cerebellum with the supratentorial association cortices that subserve nonmotor language, cognition and affect. Combined with evidence derived from experimental functional neuroimaging studies in healthy subjects and neurophysiological and neuropsychological research in patients, the role of the cerebellum has been substantially extended to include that of a crucial modulator of cognitive and affective processes. In addition to its long-established role in coordinating motor aspects of speech production, clinical and experimental studies with patients suffering from etiologically different cerebellar disorders have identified involvement of the cerebellum in a variety of nonmotor language functions, including motor speech planning, language dynamics and verbal fluency, phonological and semantic word retrieval, expressive and receptive syntax processing, various aspects of reading and writing and aphasia-like phenomena. Despite considerable efforts currently devoted to further refine typology and anatomoclinical configurations of nonmotor linguistic dysfunctions linked to cerebellar pathology, the exact underlying pathophysiological mechanisms of cerebellar involvement remain to be elucidated.
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Affiliation(s)
- Peter Mariën
- />Clinical and Experimental Neurolinguistics, CLIN, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
- />Department of Neurology and Memory Clinic, ZNA Middelheim General Hospital, Lindendreef 1, 2020 Antwerp, Belgium
| | - Alan Beaton
- />Department of Psychology, Swansea University, Swansea, Wales UK
- />Department of Psychology, Aberystwyth University, Aberystwyth, Wales UK
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Abstract
Sigmund Exner postulated in 1881 that lesions of the base of the medial frontal gyrus could specifically produce writing impairments and attributed the writing centre to this area. We report two patients who suffered from strokes in this area. These patients suffered from writing disturbances comprising both omitted words within a sentence or badly written words, as well as aphasia. These patients, in line with prior reports, illustrate the crucial role of the Exner area at the base of the medial frontal gyrus for the cerebral writing network; we suggest that this region plays an important role for phoneme-grapheme conversions.
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Affiliation(s)
- Catharina Keller
- Universitätsklinik Köln, Klinik und Poliklinik für Neurologie, Kerpener Strasse 62, Köln 50924, Germany.
| | - Ingo G Meister
- Universitätsklinik Köln, Klinik und Poliklinik für Neurologie, Kerpener Strasse 62, Köln 50924, Germany
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Abstract
A 71-year-old right-handed man was admitted to our hospital with right hemiparesis and sensory impairment associated with mild aphasia. Although aphasia gradually resolved within 2 weeks after stroke onset, his writing ability remained disturbed. A computed tomography (CT) scan at stroke onset revealed a hematoma in the left thalamus, but no cortical lesions were observed. Further, a single-photon emission CT (SPECT) scan showed decreased blood flow in the left thalamus, in the cortical region extending from the left superior temporal gyrus to the parietal lobe, and in the frontal lobe. It is possible that agraphia may have directly resulted from the thalamic lesion, but SPECT findings strongly suggested that a general decrease in left cortical function concomitant with a disruption of the thalamocortical and cortico-thalamocortical projection fibers produced these cognitive deficits.
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Affiliation(s)
- Aiko Osawa
- Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, Hidaka, Japan
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Abe K, Yokoyama R. A selective agraphia of Kana. Behav Neurol 1994; 7:79-81. [PMID: 24487291 DOI: 10.3233/ben-1994-7205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
We report a patient who developed selective Kana (phonogram) agraphia following an infarct in the left middle frontal gyrus known as Exner's area. He had well-preserved ability for comprehension, reading, and writing Kanji (ideogram). Kana errors consisted of substitution with another letter while the number of target words was well preserved. It is suggested that a dominant middle frontal gyrus lesion can result in agraphia.
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Affiliation(s)
- K Abe
- Department of Neurology, Osaka University Medical School, Japan
| | - R Yokoyama
- Division of Speech Therapy, Kishiwada Tokushukai Hospital, Japan
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