We reported a case of right hemispheric cerebral infarction due to adult moyamoya disease, which presented with crossed aphasia and visuospatial impairment. The language disorder in this case consisted of two components : 1) apraxia of speech (AOS) , whose main symptom is prosody disorder, and 2) agrammatism, which consists of particle omissions and substitutions and difficulty understanding syntax. We compared our case with previously reported cases of AOS and agrammatism due to right hemispheric lesions in a right-handed patient. Although there were no major differences in the symptoms of AOS and agrammatism between our case and previously reported cases, there were subtle differences in the lesions. The distributions of lesions suggested they were a result of chronic ischemic dysfunction caused by moyamoya disease. Our case was characterized by rapid recovery of the urge to speak despite damage to the ACA region, leaving only prosodic deficits. In adult moyamoya disease, chronic ischemic symptoms and functional reorganization may have some influence on brain distribution of language functions, including language lateralization.

  Nurturing syndrome is a psychopathologic phenomenon characterized by delusional beliefs and abnormal behaviors consistent with the idea that a deceased loved one remains alive. The mistaken belief that a dead person still lives in this world has been reported not only in nurturing syndrome but also in some cases of the Fregoli delusion. However, the relationship between the two syndromes has rarely been discussed. We report one case in which nurturing syndrome had converted to Fregoli delusion. The case was a 75-year-old right-handed woman who had lost her husband eight years earlier. She was admitted to our hospital because of infarction in the right middle cerebral artery territory. While in a private hospital room, she presented nurturing syndrome in which she continued to behave as if her husband were still alive. Next, when she moved to a rehabilitation hospital and had opportunity to meet male patients, she began to misidentify them as her husband and developed Fregoli delusion. We interpreted both syndromes as a result of autobiographical memories about her husband, the emotional responses evoked by these memories, and psychological factors such as the desire to rely on her husband. Notably, maintenance of the irrational belief that the deceased husband was still alive was thought to be linked to right frontal dysfunction. The clinical course suggested that nurturing syndrome in this case may have converted into Fregoli delusion when there were men of similar age with her husband. This is the only case we know of in which nurturing syndrome has evolved into Fregoli delusion, indicating a close relationship between the two syndromes.

  We report a case of a patient with Gogi aphasia who presented with surface dyslexia due to herpes simplex encephalitis. To investigate the mechanism of the disability, we performed a real-word and nonword oral reading task, a letter recognition task, and a lexical judgment task using Kanji stimuli. The results showed frequency and consistency effects in the real-word oral reading task, and legitimate alternative reading of components (LARC) errors appeared more frequently in reading words. The percentage of correct answers for nonwords was high, but patients recognized some nonword stimuli as lexicalization errors. For most words, the first letter was read aloud correctly, even when the words had errors. In the character recognition and lexicalization tasks, many errors were observed, in which non-existent Kanji and nonwords were identified as Japanese. Analysis using a dual route cascaded model suggested that LARC errors appeared in real words due to a failure of the semantic system. For nonwords, we hypothesized that the lexical root was incorrectly activated due to impairments in character recognition and lexical judgment, and lexicalization errors appeared in the representation of real words recalled from the first letter sound.