Lexical Agraphia Research Articles

Asymmetric Bálint’s syndrome with multimodal agnosia, bilateral agraphesthesia, and ineffective kinesthetic reading due to subcortical hemorrhage in the left parieto-occipito-temporal area

ABSTRACT We report a patient with asymmetric Bálint’s syndrome (predominantly right-sided oculomotor apraxia and simultanagnosia and optic ataxia for the right hemispace), and multimodal agnosia (apperceptive visual agnosia and bilateral associative tactile agnosia) with accompanying right hemianopia, bilateral agraphesthesia, hemispatial neglect, global alexia with unavailable kinesthetic reading, and lexical agraphia for kanji (Japanese morphograms), after hemorrhage in the left parieto-occipito-temporal area. The coexistence of tactile agnosia, bilateral agraphesthesia, and ineffective kinesthetic reading suggests that tactile-kinesthetic information can be interrupted because of damage to the fiber connection from the parietal lobe to the occipito-temporal area, leading to these tactually related cognitive impairments.

On-reading predominance over Kun-reading in progressive Gogi (Word-meaning) Aphasia: Characteristics of Kanji reading in the Japanese semantic dementia patients

Background: Progressive Gogi (word-meaning) aphasia is a Japanese manifestation of semantic dementia. Reading and writing impairments are similar to those in Western countries. Surface dyslexia and lexical agraphia (selective reading or writing impairment for irregular or exceptional words) are the cardinal features. We previously reported that On-reading preceded and Kun-reading was not recalled in reading of a single kanji character in a patient with semantic dementia.

Brodmann Areas 39 and 40: Human Parietal Association Area and Higher Cortical Function

The anatomy and function of the angular gyrus (Brodmann Area 39) and supramarginal gyrus (Brodmann Area 40) are described here. Both gyri constitute the inferior part of the parietal lobe. Association fibers from the angular gyrus project to the dorsolateral prefrontal cortex via the superior longitudinal fasciculus (SLF) II/arcuate fasciculus (AF), whereas those from the supramarginal gyrus project to the ventrolateral prefrontal cortex via SLF III/AF. Damage to the left angular gyrus causes kanji agraphia (lexical agraphia) and mild anomia, whereas damage to the left supramarginal gyrus causes kana alexia (phonological dyslexia) and kana agraphia (phonological agraphia). Damage to either gyrus causes Gerstmann's syndrome (finger agnosia, left-right disorientation, agraphia and acalculia) and verbal short-term memory impairment. "Angular alexia with agraphia" results from damage to the middle occipital gyrus posterior to the angular gyrus. Alexia and agraphia, with lesions in the angular or supramarginal gyrus, are characterized by kana transposition errors in reading words, which suggests the impairment of sequential phonological processing.

Localization of lesions in dysgraphia: An investigation in the frame of the dual-route model of spelling

Event Abstract Back to Event Localization of lesions in dysgraphia: An investigation in the frame of the dual-route model of spelling Claudio Luzzatti1*, Enrico Ripamonti2, Silvia Aggujaro3, Giuseppina Zonca4, Mirella Frustaci5 and Franco Molteni3 1 Università di Milano-Bicocca, Department of Psychology, Italy 2 IRCCS Fondazione don Carlo Gnocchi, Italy 3 Villa Beretta Rehabilitation Unit, Valduce Hospital, Costamasnaga, Italy 4 Istituti Clinici Scientifici Maugeri, IRCCS Montescano, Italy 5 ASST Rhodense, Passirana di Rho, Italy The neural bases of spelling (and its impairments) are still uncertain, and recent evidence from functional neuroimaging studies is not coherent with the results of modern aphasiology. In this study we aim at disentangling the neural bases of spelling using an anatomo-clinical correlative procedure in a cohort of 35 aphasic patients. Participants were classified as surface, phonological, mixed, undifferentiated dysgraphics using a multiple single-case diagnostic procedure. We employed the subtraction technique and voxel-based lesion-symptom mapping (VLSM) to highlight the anatomical correlates of functional damage along the lexical and sublexical routes. We found that surface dysgraphia is predominantly associated with left temporo-occipital lesions, along with lesions occurring in the left angular gyrus and supramarginal gyrus, and with partial involvement of the insula and external capsule. Phonological dysgraphia ensues from lesions in the left insular cortex, and the underlying external capsule. The left superior longitudinal fasciculus, corona radiata, and both the left putamen and pallidum seem to be involved in the sublexical network. Moreover, the middle frontal gyrus (Exner’s center) is implicated in the processing of both words and nonwords, and, as classically suggested, might be related with the grapho-motor component of writing. Data are consistent with dual-route models of spelling, and with a crucial role of white-matter pathways (in particular the external capsule) in spelling along both the lexical and the sublexical route. Figure 1 References DeMarco, A. T., Wilson, S. M., Rising, K., Rapcsak, S. Z., & Beeson, P. M. (2017). Neural substrates of sublexical processing for spelling. Brain and Language, 164, 118-128. Luzzatti, C., Laiacona, M., Allamano, N., De Tanti, A., & Inzaghi, M. G. (1998). Writing disorders in Italian aphasic patients. A multiple single-case study of dysgraphia in a language with shallow orthography. Brain, 121, 1721-1734. Roeltgen, D. P., & Heilman, K. M. (1984). Lexical agraphia. Brain, 107, 811-827. Keywords: Acquired dysgraphia, Dual-route model of spelling, Neuroimaging, Surface dysgraphia, Phonological dysgraphia Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017. Presentation Type: poster presentation Topic: Consider for student award Citation: Luzzatti C, Ripamonti E, Aggujaro S, Zonca G, Frustaci M and Molteni F (2019). Localization of lesions in dysgraphia: An investigation in the frame of the dual-route model of spelling. Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00047 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 22 Apr 2017; Published Online: 25 Jan 2019. * Correspondence: Prof. Claudio Luzzatti, Università di Milano-Bicocca, Department of Psychology, Milano, Italy, claudio.luzzatti@unimib.it Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Claudio Luzzatti Enrico Ripamonti Silvia Aggujaro Giuseppina Zonca Mirella Frustaci Franco Molteni Google Claudio Luzzatti Enrico Ripamonti Silvia Aggujaro Giuseppina Zonca Mirella Frustaci Franco Molteni Google Scholar Claudio Luzzatti Enrico Ripamonti Silvia Aggujaro Giuseppina Zonca Mirella Frustaci Franco Molteni PubMed Claudio Luzzatti Enrico Ripamonti Silvia Aggujaro Giuseppina Zonca Mirella Frustaci Franco Molteni Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Crossed Dysgraphia: A case Report

Crossed Dysgraphia: A case Report

Isolated thalamic agraphia with impaired grapheme formation and micrographia

Two patients with isolated thalamic agraphia are described. Both showed kanji (Japanese morphograms) agraphia due to impaired character recall, grapheme deformity and micrographia (progressive reduction in character size during writing) after a lesion that involved the ventral lateral and ventroposterolateral nuclei. Single photon emission computed tomography with a (99m)Tc-ethylcysteinate dimer revealed hypoperfusion in the left precentral gyrus (Brodmann Area 6) and anterior supramarginal gyrus in both. Six months later, the extent of blood flow reduction decreased in the supramarginal gyrus in both patients and the precentral gyrus in patient 1. By this time, the writing impairment improved to nearly the normal range. Our study suggests that kanji agraphia (corresponding to lexical agraphia in Western countries) with poor grapheme formation and micrographia arises from a lesion in the ventral lateral and ventroposterolateral nuclei in the left thalamus. The accompaniment of poor grapheme formation and micrographia may reflect disruption of the cortico-subcortical motor circuit involving the putamen, thalamus, premotor cortex and sensorimotor cortex. It is also suggested that multiple cortical sites can be a target for secondary dysfunction that yields agraphia in a thalamic lesion, and that the recovery of reduced cortical blood flow does not always proceed in parallel with that of agraphia.

Semantic dementia with lower motor neuron disease showing FTLD-TDP type 3 pathology (sensu Mackenzie)

We describe a case of frontotemporal lobar degeneration with semantic dementia and lower motor neuron disease. A 63-year-old man presented with the full clinical picture of semantic dementia, including semantic anomia, surface alexia, lexical agraphia, associative agnosia, prosopagnosia and phonagnosia. Flaccid dysarthria, bulbar dysphagia and fasciculations developed 7 years after onset, followed by death within a year. The neuropathological examination showed heavy neuronal loss in the anterior temporal lobe cortex, dorsal vagal and hypoglossal nuclei and anterior horns of the spinal cord. Ubiquitin- and TDP-43-positive cytoplasmic inclusions were abundant in layer II of affected cortices and in granular cells of the hippocampal dentate gyrus, whereas dystrophic neurites were sparse and intranuclear inclusions absent. It is concluded that FTLD-TDP type 3 can be associated with semantic dementia and lower motor neuron disease in combination.

The role of left posterior inferior temporal cortex in spelling.

To determine whether damage to left posterior inferior temporal cortex (PITC) is associated with agraphia and to characterize the nature of the spelling impairment. Left angular gyrus may play a critical role in spelling. However, this traditional view is challenged by reports of agraphia after left temporo-occipital lesions and by functional imaging studies demonstrating activation of left PITC during writing in normal individuals. Patients with focal damage to the left temporo-occipital cortex and normal control subjects were administered a comprehensive spelling battery that included regular words, irregular words, and nonwords as stimuli. Although patients performed worse than control subjects in all experimental conditions, the spelling deficit was particularly severe for irregular words, whereas regular word and nonword spelling were less impaired. Additional analyses indicated that orthographic regularity and word frequency had a much more pronounced effect on spelling accuracy in patients compared with control subjects. Most errors on irregular words were phonologically plausible, consistent with reliance on a sublexical phonologic spelling strategy (i.e., phoneme-grapheme conversion). Overall, the spelling impairment of the patients showed the characteristic profile of lexical agraphia. Lesion analyses indicated that the damage in the majority of patients encompassed an area within the left PITC (BA 37/20) where the authors previously obtained evidence of activation in a functional imaging study of writing in normal participants. The behavioral and neuroanatomic observations in the patients are consistent with functional imaging studies of writing in neurologically intact individuals and provide converging evidence for the role of left PITC in spelling. Together, these findings implicate left PITC as a possible neural substrate of the putative orthographic lexicon that contains stored memory representations for the written forms of familiar words.

Alexia caused by a fusiform or posterior inferior temporal lesion

We evaluated the alexia and agraphia of three patients with different lesions using Japanese kanji (morphograms) and kana (phonograms) and made a lesion-to-symptom analysis. Patient 1 (pure alexia for both kanji and kana and minor agraphia for kanji after a fusiform lesion) made more paragraphic errors for kanji, whereas patient 2 (alexia with agraphia for kanji after a posterior inferior temporal lesion) showed severe reading and writing disturbances and more agraphic errors for kanji. Brodmann Area 37 was affected in both patients, but in patient 2 the lesion was located lateral to that in patient 1. Patient 3 showed agraphia without alexia after restricted lesion to the angular gyrus. We believe that pure alexia (patient 1) results from a disconnection between the medial fusiform gyrus and posterior inferior temporal area (the lateral fusiform and inferior temporal gyri), whereas alexia with agraphia for kanji (patient 2), corresponding to lexical agraphia in Western countries, results from damage to the posterior inferior temporal area, in which whole-word images of words are thought to be stored. Furthermore, restricted lesion in the angular gyrus (patient 3) does not produce alexia; the alexic symptom of “angular” alexia with agraphia may be the result of damage to the adjacent lateral occipital gyri.

Lexical Agraphia in the Writing of George Fox

Lexical Agraphia in the Writing of George Fox by Raymond Ayoub and David Roeltgen* Introduction and purpose George Fox (1 624-1 691) was an extraordinary person in many ways, yet there is an aspect of his life and works which, we feel, requires some clarification and explanation. That aspect deals with his writing and written expression, in contrast to his reported verbal skills. Virtually all of the writings attributed to him are the result of dictations to scribes or are transcriptions from various sources. While these works are very extensive, there is but a negligible amount (about 30 samples) in his own handwriting and these typically are lacking in syntactic, linguistic and grammatical structure. These deficiencies have been recognized by writers, but no compelling explanation has been proposed. To account for these shortcomings, we suggest, in this essay, that Fox was afflicted with congenital or acquired agraphia of the type called lexical. Agraphia is a neurological condition which can severely inhibit the victim's ability to transfer thoughts into written form. Several forms of agraphia have been identified and these are rooted in distinct cerebral pathology. It is only recently, however, that some insight into the neurological basis of the various forms has been proposed and studied. One of the authors (Roeltgen) has studied this phenomenon for a number of years and has developed objective criteria as a diagnostic tool. While the semantic and syntactic deficiencies in Fox's writing are striking and substantial, there are at present no objective criteria for measuring these; we must therefore base ourcase onhis spelling. Roeltgen's objective procedure for identifying lexical agraphia is through spelling errors. In practice, the subject is evaluated with the help of 'non-words' and the subject's phonological abilities are systematically tested. In the case of Fox, however, we must necessarily rely on the limited amount of material that is available, but we are confident that this material is sufficient to support our conclusion. It is well-known that the spelling of words has varied over the centuries and that there was no uniformity of spelling in the 16th and 17th centuries. ?Raymond Ayoub, Ph.D. is emeritus professor of mathematics at Penn State University. His interest in Fox's writing arises from a project to construct a mathematical model of writing that characterizes authorship. David Roeltgen, M.D., practices neurology in Williamsport, PA. His research in Agraphia has been supported by the National Institutes ofHealth. He has collateral interest in neurological pathology of historical figures. Lexical Agraphia39 Certain spellings, different from contemporary ones, were common and the strictures were much more permissive than they are today. In Fox's case, we are not alarmed when he writes the target word "augmentation" as "ogmentashon" or "disciples" as "disípeles," for these spellings arephonologically sound. When, however, he writes "condemnation" as two words "cond menshon" or "minds" as "imdes" or "persecute" as "perut" or Ephes. (abbreviation of Ephesians) as "fies", our suspicions are aroused, for these errors are characteristic of the type of aberration found in current investigations into agraphia. Roeltgen's technique is to characterize errors as proximate or distant, the distinction being based on the phonemic structure of the word.1 The Setting For the most part, Fox's autographs can be characterized as lacking in organization, in some cases to the point of incoherence.2 Several manuscripts are pure narratives and are readable but all manuscripts exhibit distant spelling errors. On the other hand, some publications are attributed to Fox but are in the hand of a scrivener. The syntax is greatly improved but some features remain which we call Foxian. We have verified in several cases that the same scriveners, writing independently, do so with organization and clarity. Although one can cite examples oferratic writing from thatenvironment, the deficiencies exhibited by Fox are far from being characteristic of the period. Indeed, the examination of about 50 documents, from the "Swarthmore Manuscripts" (see note 25), written by Quaker contemporaries of Fox, failed to reveal a single example of this lack of structure. More significantly, the spelling "errors" are never of the type we have called distant. Nor does Fox's problem stem from an inability...

Discrepant Oral and Written Spelling after Left Hemisphere Tumour

Repetition, reading, confrontation naming, and oral and written spelling were studied in a 57 year-old man with a left hemisphere tumour. These tasks were repeated over a period of two weeks when the patient was being treated for brain oedema prior and subsequent to neurosurgical intervention. In the context of intact repetition and good reading, the most striking finding was a significant qualitative and quantitative discrepancy between oral and written spelling, with the latter task more severely affected. The pattern on oral spelling was that of lexical (or surface) agraphia. On written output, however, orthographic errors predominated. The relatively greater impairment of written spelling was not secondary to a motoric or visuo-spatial deficit. The observed patterns are not easily accommodated by current models of writing.

PHONOLEXICAL AGRAPHIA

Study of neuropsychological sequelae of a focal acquired brain lesion may bring out and help delineate the features of a compensated developmental language disorder and its anatomical substrate. A left-handed man with a history of phonological developmental dyslexia and dysgraphia learned in early adulthood to read and write using a lexical system. Following a small posterior right parietal infarct when aged 56 yrs he developed a severe agraphia displaying features of phonological dysgraphia with impaired segmentation and features of lexical agraphia. Writing was severely impaired for all classes of word and nonword stimuli but his errors did not resemble those attributable to a deficit in the system responsible for the short-term storage of the graphemic representation of a word (graphemic output buffer). These observations imply that an acquired lexical agraphia has been superimposed on his developmental phonological dysgraphia, resulting in a combined or 'phonolexical' agraphia.

Pure agraphia of kanji due to thrombosis of the Labbe vein.

A case is described of a 56 year old Japanese male with pure agraphia of kanji (the Japanese morphograms) due to haemorrhagic infarction of the left temporal lobe caused by the rare condition of cortical vein thrombosis of Labbé. Writing kanji was severely impaired without disturbed consciousness, aphasia or apraxia. On the other hand, writing kana (the Japanese syllabograms), and reading kanji and kana were almost intact. This suggests that the process of writing kanji involves a different pathway from that of reading kanji in the left temporal lobe. Pure agraphia of kanji is considered to be similar to lexical agraphia in Indo-European languages, in that the writing system with a poor or irregular phoneme-grapheme transformation is impaired by the left temporal lesion. This case indicates the necessity for considering thrombosis of the Labbé vein when a subcortical haematoma is detected in a temporal lobe on computed tomography of the brain.

LEXICAL AGRAPHIA IN THE JAPANESE LANGUAGE

A new syndrome of 'pure agraphia for Kanji' is described in 3 Japanese subjects with lesions in the left posteroinferior temporal region. Kanji (ideogram or morphogram) can be compared with orthographically irregular or ambiguous words in some European languages, since it is impossible to write Kanji characters unless each one of them is learned and memorized. In contrast, Kana (phonogram or syllabogram) words are comparable with orthographically regular words or nonsense words, because the Kana writing system depends on strict phonological rules (almost one-to-one correspondence between syllable and syllabogram). We conclude that 'lexical agraphia' reported in European languages can also be observed in the Japanese language where it is expressed as 'pure agraphia for Kanji'. 'Lexical agraphia' is a useful concept with general application regardless of language system.

Developmental phonological and lexical agraphia in adults

Many cases of agraphia from acquired cerebral lesions may be divided into two groups, phonological and lexical, suggesting two dissociable spelling systems. Studies of developmental agraphia have described some children who have spelling patterns similar to acquired phonological or lexical agraphia. This study analyzed spelling results from 22 adolescent and adult subjects with developmental agraphia (DA) and compared them to those from control subjects and subjects with acquired agraphia (AA). On the basis of spelling ability, subjects with DA could be divided into two groups. Analysis of the profile of spelling abilities indicated that the two groups of subjects with DA were almost indistinguishable from the two groups of subjects with AA, phonological and lexical. This supports the contention that DA in adults may be divided into phonological and lexical groups and further supports the two-system hypothesis for linguistic agraphia.

Lexical agraphia from focal lesion of the left precentral gyrus

Lexical agraphia reflects a dysfunction of the lexical spelling system and is characterized by better spelling of nonwords and regular words than irregular words. All previously reported cases with documented focal lesions had involvement of temporo-parieto-occipital regions. We now report a case of lexical agraphia following a discrete lesion of the left precentral gyrus. Our case complements previous neuroanatomical accounts of agraphia and provides further support for the independence of neuronal systems that mediate spelling from those involved in spoken language and reading.

Isolated lexical agraphia in a right-handed patient with a posterior lesion of the right cerebral hemisphere

Lexical agraphia is thought to result from impairment of the lexical spelling system and is characterized by better spelling of nonwords and regularly spelled words than irregularly spelled words. Previous reports have suggested a localization of this syndrome in the region of the left posterior-superior angular gyrus and parietal-occipital lobule, sparing the supramarginal gyrus. We describe a right-handed man who after open-heart surgery displayed lexical agraphia without aphasia, alexia, apraxia, or Gerstmann's syndrome. Computed tomography disclosed a lesion not on the left but on the right in the posterior parietal-occipital region.

LEXICAL AGRAPHIA

Eight patients with acquired agraphia were studied using the same writing tests and were compared with normal and brain-damaged controls. Four patients fulfilled the criteria for lexical agraphia and on CT scan had lesions of the posterior angular gyrus that spared the supramarginal gyrus. The other 4 fulfilled the criteria for phonological agraphia. They had lesions on CT scan that were similar to those found in previously described patients with phonological agraphia. Their lesions involved the supramarginal gyrus or insula deep to it and spared the angular gyrus. These studies support the hypothesis that there are two dissociable spelling systems and that these spelling systems are disrupted by focal lesions in separate but distinct brain regions. Further studies investigated the relationships between phonological agraphia and phonological dyslexia (alexia), and lexical agraphia and surface dyslexia (lexical alexia). The data support the hypothesis that individual systems subserve the four processes of phonological spelling, phonological reading, lexical spelling and lexical reading.