Del Grosso Destreri N, Farina E, Alberoni M, Pomati S, Nichelli P, Mariani C
Neurorehabilitation Unit, University of Milan, Milan, Italy.
Brain Lang. 2000 Feb 15;71(3):353-72. doi: 10.1006/brln.1999.2274.
We report a patient who, after a left parieto-occipital lesion, showed alexia and selective dysgraphia for uppercase letters. He showed preserved oral spelling, associated with handwriting impairment in all written production; spontaneous writing, writing to dictation, real words, pseudowords, and single letters were affected. The great majority of errors were well-formed letter substitutions: most of them were located on the first position of each word, which the patient always wrote in uppercase (as he used to do before his illness). The patient also showed a complete inability to access the visual representation of letters. As demonstrated by a stroke segmentation analysis, letter substitutions followed a rule of graphomotor similarity. We propose that the patient's impairment was at the stage where selection of the specific graphomotor pattern for each letter is made and that the apparent selective disruption of capital case was due to a greater stroke similarity among letters belonging to the same case. We conclude that a visual format is necessary neither for spelling nor for handwriting.
我们报告了一名患者，其左侧顶枕叶病变后出现失读症和大写字母选择性书写障碍。他的口头拼写能力保留，但在所有书写形式中均伴有书写障碍；自发书写、听写、实词、假词和单个字母书写均受影响。绝大多数错误是拼写正确的字母替换：其中大多数位于每个单词的首位，患者总是用大写字母书写（就像他生病前那样）。该患者还表现出完全无法获取字母的视觉表象。通过笔画分割分析表明，字母替换遵循图形运动相似性规则。我们认为，患者的损伤处于为每个字母选择特定图形运动模式的阶段，而大写字母明显的选择性破坏是由于同一大小写的字母之间笔画相似性更高。我们得出结论，拼写和书写都不需要视觉形式。
