We examined the longitudinal transition on copying and drawing of a patient with unilateral neglect who had lesion in the right hemisphere. The findings were as follows. Firstly, the copying of cube perspective figure in the patient developed from the two dimensional squares overlapped each side of a cube to the three dimensional figure missed left side of the cube. This process of the cube copying revealed the growth of perceptual representation in the brain. Secondly, the patient drew only the right side of flower in the fourth copying (323 days after lesion), but he drew the left side of leaves in the second and third copying (82 and 102 days). In these copying, he drew interestingly half of the leaf on the left. This finding suggested that it was appropriate to consider unilateral spatial neglect at the object-centered coordinate frame than the viewer-centered coordinate frame. Thirdly, thinking activity participates deeply in drawing, therefore, drawing is more highly flexible than copying. Longitudinal observations on copying and drawing of the case suggested that copying was appropriate for evaluation of unilateral spatial neglect than drawing.
Accurate diagnosis of frontotemporal dementia is challenging in early stages. This is especially true for right temporal variant of frontotemporal dementia, which has no separate diagnostic criteria yet due to its relatively equivocal symptoms. Here we present a case with right temporal variant frontotemporal dementia who presented with alcohol dependency, language without social context, and remarkable behavioral symptoms and was first misdiagnosed as having alcohol-related dementia. He was precisely diagnosed eight years after symptom onset, when he revealed prosopagnosia, difficulty recognizing his housemates, social cognition and knowledge impairment, semantic memory impairment, loss of empathy, ritualistic behaviors, and difficulty finding and comprehending words. Retrospectively, his alcohol dependency itself was considered an early manifestation of right temporal variant frontotemporal dementia. We discussed the characteristics of right temporal variant frontotemporal dementia using symptoms of our present case as well as findings from past literature. Abnormal behaviors might be derived partly from impairment of social contextual cognition and social knowledge as well as semantic memory impairment.
A right-handed 54-year-old man showed agraphia and acalculia was not able to continue the office work and visited our hospital one year later. He showed slight rigidity and dystonic posture on his right arm. Graphesthesia was found on his right-dominant hands. His main symptoms were significant agraphia, acalculia, ideomotor apraxia, ideational apraxia, and right-dominant limb kinetic apraxia, and logopenic aphasia. His amnesia did not disturb the episodic memory. Brain MRI showed left-dominant bilateral cortical atrophy which was included by the entity of posterior cortical atrophy (PCA). 99mTc-ECD SPECT showed the decreased blood flow on around left angular gyrus and central gyri. DaT Scan showed the mild decreased accumulation on mild left striatum. 11C-PiB PET presented the positive accumulation. His significant agraphia on Japanese characters (kana) and Chinese characters, and apraxia was possible to be caused by the wide functional deficits on around left angular gyrus and it’s dorsal and ventral areas. We suspected the candidate pathology were corticobasal degeneration (CBD) or Alzheimer disease (AD).