Dysgraphia after right hemisphere stroke.

Acquired dysgraphia has been described as a disorder of graphemic selection and spatial temporal disorganization which can exist in isolation or as a component of a broader language or cognitive syndrome. There is little agreement on the locus of writing centers, although select areas within the left hemisphere have been suggested. We describe a patient who had dysgraphia after a right hemispheric stroke. He had no demonstrable signs of limb apraxia or visual field deficit, and only subtle signs of language impairment other than the writing disturbance. Treatment emphasized progressively more complex writing tasks which included the following: (1) written responses to picture/word stimuli, (2) word and sentence dictation, and (3) self-generated sentences and functional writing tasks. At discharge from the hospital the patient's writing was within normal limits. Our findings were similar to those described for a patient with a left hemispheric stroke who was primarily dysgraphic. We conclude that our patient's dysgraphia was a component of a subtle aphasia as well as a spatial temporal disorganization disorder.