Spatial agraphia.

Twenty-one patients with right hemisphere damage were studied (11 men, 10 women; average age = 41.33; age range 19-65). Subjects were divided into two groups: pre-Rolandic (6) and retro-Rolandic (15) right hemisphere damaged patients. A special writing test was given to each patient. The writing errors observed included literal substitutions, feature omissions and additions, letter omissions and additions, inability to maintain horizontal writing, inappropriate grouping and fragmentation of elements, and changes in handwriting style. Associated disorders included left-hemiparesis, visual field defects, spatial hemi-neglect, constructional apraxia, spatial alexia, and spatial acalculia. It is proposed that spatial agraphia is related to: (1) left hemi-neglect, (2) constructional deficits, (3) general spatial defects, and (4) some motor disautomatization and tendency to perseverate. In cases of right frontal damage, motor-associated deficits (iterations of features and letters) predominated, whereas in cases of posterior right hemisphere damage, spatial defects (inappropriate distribution of written material in the space, grouping of letters belonging to different words, and splitting of words) were more evident. Writing impairments are in general more noticeable in cases of retro-Rolandic damage.