Sakurai Yasuhisa, Onuma Yoshinobu, Nakazawa Gaku, Ugawa Yoshikazu, Momose Toshimitsu, Tsuji Shoji, Mannen Toru
Department of Neurology, Mitsui Memorial Hospital, Tokyo, Japan.
Behav Neurol. 2007;18(2):99-114. doi: 10.1155/2007/906417.
To characterize various dysgraphic symptoms in parietal agraphia.
We examined the writing impairments of four dysgraphia patients from parietal lobe lesions using a special writing test with 100 character kanji (Japanese morphograms) and their kana (Japanese phonetic writing) transcriptions, and related the test performance to a lesion site.
Patients 1 and 2 had postcentral gyrus lesions and showed character distortion and tactile agnosia, with patient 1 also having limb apraxia. Patients 3 and 4 had superior parietal lobule lesions and features characteristic of apraxic agraphia (grapheme deformity and a writing stroke sequence disorder) and character imagery deficits (impaired character recall). Agraphia with impaired character recall and abnormal grapheme formation were more pronounced in patient 4, in whom the lesion extended to the inferior parietal, superior occipital and precuneus gyri.
The present findings and a review of the literature suggest that: (i) a postcentral gyrus lesion can yield graphemic distortion (somesthetic dysgraphia), (ii) abnormal grapheme formation and impaired character recall are associated with lesions surrounding the intraparietal sulcus, the symptom being more severe with the involvement of the inferior parietal, superior occipital and precuneus gyri, (iii) disordered writing stroke sequences are caused by a damaged anterior intraparietal area.
描述顶叶失写症的各种书写障碍症状。
我们使用一项特殊的书写测试，即100个汉字（日文字母）及其假名（日语拼音文字）转录，对4名因顶叶病变导致失写症的患者的书写障碍进行了检查，并将测试表现与病变部位相关联。
患者1和患者2有中央后回病变，表现出字符变形和触觉失认症，患者1还伴有肢体失用症。患者3和患者4有顶叶上小叶病变，具有失用性失写症的特征（字母变形和书写笔画顺序障碍）以及字符意象缺陷（字符回忆受损）。字符回忆受损和字母形成异常的失写症在患者4中更为明显，其病变延伸至顶叶下部、枕叶上部和楔前回。
目前的研究结果及文献综述表明：（i）中央后回病变可导致字母变形（躯体感觉性失写症），（ii）字母形成异常和字符回忆受损与顶内沟周围的病变有关，随着顶叶下部、枕叶上部和楔前回的受累，症状会更严重，（iii）书写笔画顺序紊乱是由顶内前区受损引起的。
