We reported a case of pure agraphia of Kanji due to left temporal tumor. K. S. is a right-handed 75-year-old male. On 8th February, 1999, he suddenly experienced writing difficulty with Kanji but not Kana or Katakana. His reading ability for both Kanji and Kana was normal. MRI revealed left temporal tumor which occupied mainly Wernicke's area with perifocal edema. SPECT with ECD revealed widespread low blood flow in the left temporal lobe. Inability of Kanji writing was drastic and persisted during anti-edema therapy with steroids. The patient was able to copy presented Kanji quickly and correctly at a glance of the given target. Although he also showed mild Wernicke aphasia, common conversation was almost intact.
Recently many authors have reported specific agraphia of Kanji due to left posteroinferior temporal damage. But most cases showed agraphia and alexia of Kanji initially, and later only agraphia of Kanji remained. In the case of K. S., however, agraphia of Kanji appeared suddenly.
Usually each Kanji has several pronunciations, and any given pronunciation corresponds to several Kanji. That is, Kanji and pronunciations form correspondences of many to many. Kana form correspondences of one to one, with some exceptions. To write Kanji words correctly, semantic control is believed to be necessary. We postulated that both Kana and Kanji are controlled by semantics, pronunciation and letter form. Kana writing is thought to be mainly controlled by pronunciation and Kanji writing equally controlled by all three factors.
To date, “visual images” of letters are thought to be stored in the left angular gyrus, and many reports of agraphia have been based on this assumption. But the concept of “visual images” of letters is very ambiguous. Here we propose a new writing and reading system for Kanji and Kana which emphasizes the concept of “control” to the frontal motor area. In addition we postulate that “visual images” of letters do not exist in the left angular gyrus.
View full abstract