2014 Volume 34 Issue 2 Pages 242-251
A 78-year-old right handed-patient showing progressive nonfluent aphasia following corticobasal syndrome (CBS) demonstrated diverse writing disorders. She developed speech and writing disorders as initial symptoms. SPECT showed decreased blood flow in the frontal, temporal, and parietal lobes.Hypoperfusion was more prominent in the left hemisphere. Her motor symptoms were more frequent on the right side. Language and neuropsychological tests revealed mild nonfluent aphasia, disorders of writing, apraxia, disability of kinetic reading, constructional deficit, and mild intellectual disability. Naming, repetition, and attentional abilities were preserved. The patient displayed diverse dysgraphia as follows; apraxic, spatial, afferent and lexical agraphias, paragraphia of Kana, and omission of Kana letters. The peripheral agraphia in this patient was apraxic agraphia due to dysfunction of the left parietal lobe, while spatial agraphia and afferent agraphia which showed addition and omission of strokes in Kanji writing could be caused by disability of the right hemisphere. As central agraphias, lexical agraphia in Kanji induced by impairment of the semantic system involving the left temporal lobe, paragraphia in Kana letters due to left frontal lobe damage, and omission of Kana letters possibly concerned with disturbance of bilateral frontal lobes were observed. Writing and copying of words or sentences were preserved. We proposed that her diverse agraphias with CBS could be associated with dysfunction of not only the left but also the right hemisphere, the latter being closely related to visuospatial function as well as visual and kinetic feedback.
