There are several forms of agraphia, including: aphasic agraphia, where patients have impairments in writing the correct words or correctly spelling words; apraxic agraphia, where patients are impaired in making the movements needed to write letters; and spatial agraphia, where patients might fail to write letters on one side of a word or write on one side of a page. In several of these agraphic disorders, patients can make perseverative errors, and perseverative errors can even be seen in patients who do not have aphasia or apraxic agraphia. Patients who make continuous perseverative errors repeatedly writes the same letter (fruuuit) or word, and patients with recurrent perseverations change their letters, but then incorrectly use letter or word that was previously used (fruiut). We report a patient who demonstrated a different form of graphic perseveration.
A 61-year-old man with a right parietal lobe lesion and left-sided neglect developed an inability to write. When attempting to write, he repeatedly wrote the same letter that he first wrote, and wrote these in the same spatial position as the first letter. When spelling, reading aloud, and using a keyboard to write he did not perseverate letters or words. When performing the cancellation test and drawings, he also perseverated.
This patient demonstrated a novel form of perseverative behavior. Although the mechanism of this spatially adherent graphemic perseveration remains to be elucidated fully we provide evidence that this patient's right parietal lesion caused a visuomotor disengagement disorder.
Department of Neurology, The Center for Neuropsychological Studies, University of Florida College of Medicine, and the Veteran's Affairs Medical Center, Gainesville, FL
Reprints: Waldo Rigoberto Guerrero, MD, Department of Neurology, The Center for Neuropsychological Studies, University of Florida College of Medicine, and the Veteran's Affairs Medical Center, Gainesville, FL (e-mail: firstname.lastname@example.org).
Supported in part by the State of Florida Memory Disorders Clinics and the Research Service of the VAMC.
Received August 31, 2009
Accepted July 1, 2010