Using writing characteristics to determine the mechanism of apraxic agraphia caused by cerebral hemorrhage in the left parietal lobe Yasuko Seki 1 , Yasuhiro Miyazaki 2 , Tsuguto Takizawa 3 1Department of Rehabilitation Medicine, Saitama Medical University Medical Center 2Department of Sensory Sciences, Kawasaki University of Medical Welfare 3Department of Neurological Surgery, The University of Tokyo Hospital Keyword: 失行性失書 , 左上頭頂小葉 , 文字視覚心像 , 書字運動プログラムの障害 , apraxic agraphia , left superior parietal lobule , grapheme (visual imagery of letters) , impairment of motor program for writing pp.126-136
Published Date 2014/6/15
DOI https://doi.org/10.11477/mf.6001100414
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 We report a 17-year-old right-handed female who showed agraphia due to cerebral hemorrhage in the left parietal lobe. She showed no symptom of aphasia, dyslexia, or limb apraxia. Although the constructional disorder resolved rapidly, her handwriting was slow and effortful and written letters were poorly constructed. Orally, however, she could express gross graphemic figures of kana and kanji letters that she couldn't write. This implies that the visual imagery of letters was preserved. We considered this case to be apraxic agraphia. On dictation of kanji and kana, the most common error type was structural. Kanji was more difficult to write than kana. Her stroke order was inconsistent. In some kanji, she reached the correct order after trial and error, and in others she failed, became confused, and gave up. When copying letters, stroke order and brush stroke order remained abnormal, but the degree of abnormality was reduced and her letter figures improved. These results suggest that her apraxic agraphia has two underlying factors:1) impairment of motor program for writing letters;and 2) complications due to the weakness of the bidirectional route connecting grapheme (visual imagery of letters) and motor program for writing.

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