title: Selective uppercase dysgraphia with loss of visual imagery of letter forms: a window on the organization of graphomotor patterns.
abstract: 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.
authors.affiliation: Neurorehabilitation Unit, University of Milan, Milan, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Del Grosso Destreri
authors.forename: E
authors.initials: E
authors.lastname: Farina
authors.forename: M
authors.initials: M
authors.lastname: Alberoni
authors.forename: S
authors.initials: S
authors.lastname: Pomati
authors.forename: P
authors.initials: P
authors.lastname: Nichelli
authors.forename: C
authors.initials: C
authors.lastname: Mariani
mesh_terms: D000368:Aged; D000381:Agraphia / Q000150:complications / Q000175:diagnosis*; D004410:Dyslexia / Q000150:complications / Q000175:diagnosis*; D006423:Hemianopsia / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011596:Psychomotor Disorders / Q000150:complications / Q000175:diagnosis*; D012720:Severity of Illness Index; D014794:Visual Fields / Q000502:physiology