Abstract
In this report, we describe a 35-year-old right-handed man with MELAS who was followed up for 14 months, focusing on his dysgraphia. MRI performed at the initial examination revealed extensive lesions in the left parietal, temporal, and occipital lobes, and in a subsequent examination after recurrence of a stroke-like episode, similar lesions were found in the corresponding areas of the right hemisphere. After the first stroke-like episode, the patient presented with amnestic aphasia, agraphia for Kanji, and an inability to recall visual images. About 6 months later, he had another episode resulting in worsening of dysgraphia and new symptoms of left hemispatial neglect, visual agnosia with various visuospatial deficits, dyspraxia, and constructional disability. He was unable to even copy a Kanji character. When writing Kana letters, he made unusual errors such as rotation or omission of the strokes of the letters and left some strokes uncrossed when they should be crossed. He also had difficulty in copying figures. It was revealed that he was able to draw a line from one point to another and trace letters, i. e., his ability to draw strokes of letters was preserved. However, when observing a dot or line presented on a stimulus sheets, he failed to reproduce its location on a blank sheet of paper. In another experiment, he had difficulty in judging whether or not two successively displayed dots appeared at the same location. It is suggested that these disturbances after the second episode are associated with disability to focus on multiple objects simultaneously, disturbance of visual perception of object orientation, and deficit of internal visuospatial coordinates.
