Visuospatial image deficits have been reported in cases after injury in the right hemisphere, in particular, the right parietal lobe. Although there is an excellent Japanese article on Gerstmann’s syndrome (Nagai et al 2001) that involved a deficit of mental image manipulation, few case studies have been performed on visual/visuospatial image deficits following the left parietal lobe damage. In this article, a unique type of visual/visuospatial image deficits was described, which occurred in two cases after the left parietal damage. One had difficulties in holding, retrieving, and manipulating visual images concerning Chinese characters, Arabic numerals, and specific body postures in Tai Chi. Difficulties of the other one involved recalling the order of the Japanese syllabary and the Arabic numerals as well as the steps of cooking and transfer of trains, all of which might be regarded as dorsal simultanagnosia for conceptual space. Taking together, these deficits might be related to inabilities to retrieve, hold, and manipulate images that involve man-made concepts such as characters, which contrast with concrete visuospatial images of the outer world that are disrupted by the right parietal lobe injury.
In multiple sclerosis (MS), aphasia is rarely observed, although cognitive dysfunction is frequent. Recently, we experienced a right-handed 42-year-old woman with secondary progressive MS who showed difficulty in word finding and characteristic paraphasia. Although she had a long duration of illness, since she developed MS at the age of 14, she showed no obvious physical dysfunctions. In contrast, in addition to the semantic paraphasia, unrelated paraphasia was observed. Examinations suggested that dysfunction in the categorization of words that probably associate with frontal lobe dysfunction might have caused her characteristic paraphasia.