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Isolated thalamic agraphia with impaired grapheme formation and micrographia

Journal of Neurology volume 258, pages 1528–1537 (2011)Cite this article

Abstract

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 99mTc-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.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Affiliations

  1. Department of Neurology, Mitsui Memorial Hospital, 1, Kanda-Izumi-cho, Chiyoda-ku, Tokyo, 101-8643, Japan

    Yasuhisa Sakurai, Koki Sato, Izumi Sugimoto & Toru Mannen

  2. Department of Endoscopy, Tokyo Jikeikai Medical University Aoto Hospital, Tokyo, Japan

    Yukinaga Yoshida

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  1. Yasuhisa Sakurai
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  2. Yukinaga Yoshida
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  3. Koki Sato
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  4. Izumi Sugimoto
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  5. Toru Mannen
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Correspondence to Yasuhisa Sakurai.

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Sakurai, Y., Yoshida, Y., Sato, K. et al. Isolated thalamic agraphia with impaired grapheme formation and micrographia. J Neurol 258, 1528–1537 (2011). https://doi.org/10.1007/s00415-011-5981-5

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  • DOI: https://doi.org/10.1007/s00415-011-5981-5

Keywords

  • Apraxic agraphia
  • Pure agraphia
  • Alexia with agraphia
  • Kanji
  • Kana
  • Chinese characters