A 61 year-old right-handed artist who had suffered from cerebral infarction 8 months previously showed remarkable improvement of severe left unilateral spatial neglect and crossed aphasia following rehabilition.
At the initial neurologic and neuropsychologic evaluation at our hospital, the patient showed left hemiplegia, aphasia and left unilateral spatial neglect. The patient had tight right-handedness and no familial left-handedness. A training program of crayon drawing was begun because the patient was known to be an artist formerly, After 15 months of training, one of his pictures was accepted for an exhibition. The training program thus proved useful for the patient.
    The crossed aphasia showed moderate improvement but trans-word disturbance and agrammatism remaind.
    The original region of left unilateral spatial neglect in this case was suspected to be the right, parieto-temporo-occipital area.

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    In a case of typical constructional agraphia we found that a perceptive impairment of letters played an important role. The patient was a 43-year-old right-handed woman with high level of orthographic capacity. She was referred to our hospital because of difficulty in writing and calculation. A CT scan revealed a low-density lesion in the subcortical area of the left supramarginal gyrus. Neuropsychologically she demonstrated constructional apraxia, limb-kinetic apraxia, ideomotor apraxia, ideational apraxia and mild aphasia. No visual agnosia for objects was confirmed.
    Major difficulties were observed in writing, where the patient showed inpairments in spontaneous writing and copying letters. In copying difficulties were most marked with Kanji letters. Among Kanji, difficulty increased as the number of strokes contained in the Kanji increased. Types of errors included omission, repetition and displacement of strokes. Occasionally she would not write at all. Aphasic errors such as paragraphias were not observed. Because all errors in copying were spatial, we examined her perceptual capacity of letters in detail. It was shown that the patient would read presented letters without paying attention to their detail. She was unable to detect errors in a shown letter which varied slightly from a correct one.
    From this experience we speculate three stages in letter copying. The first process involves gross matching of a presented visual stimulus with the stored visual image of letters, i. e. categorization. The second process involves more detailed analysis of the stimulus letter. In this process the stimulus letter is closely scanned along with the presumed letter image. For a complex figure such as Kanji with many strokes this scanning process seems to be indispensable to detect small anomalies of the stimulus. With this “active” imagery exploration, visual perception of a letter becomes complete. The third and final process involves actual motor writing mobilizing the kinesthetic image of letters.
    In the present case it was the second process which was defective. Without this exploratory visual process, writing of a complex letter such as a Kanji becomes difficult.

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