title: Damage to the upper portion of area 19 and the deep white matter in the left inferior parietal lobe, including the superior longitudinal fasciculus, results in alexia with agraphia.
abstract: Analysis of lesions and symptoms in patients with brain tumors combined with information from diffusion tensor imaging provides direct evidence of the anatomical localization of brain function. Using these methods, we evaluated 8 patients who underwent surgery for metastatic brain tumors located in the left occipital lobes between 2007 and 2009. Preoperatively, 4 patients (cases 1-4) had alexia with agraphia while the other 4 patients (cases 5-8) did not. Tractography for the superior longitudinal fasciculus (SLF) was performed before surgery in case 1. The common brain tumors in cases 1-4 were located in the upper portion of area 19, and peritumor edema in that area resulted in compromise of the deep white matter of the inferior parietal lobe (IPL). The SLF was compressed and disrupted in the white matter of the IPL near the upper portion of area 19 in case 1. In cases 5-8, the brain tumors were not located in the upper portion of area 19. These results suggest that damage to the upper portion of area 19 and to the white matter in the left IPL, including the SLF, resulted in alexia with agraphia.
authors.affiliation: Department of Neurosurgery, Komagome Metropolitan Hospital, Bunkyo-ku, Tokyo, Japan. shinoura@cick.jp
authors.forename: Nobusada
authors.initials: N
authors.lastname: Shinoura
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Onodera
authors.forename: Kotoyo
authors.initials: K
authors.lastname: Kurokawa
authors.forename: Masanobu
authors.initials: M
authors.lastname: Tsukada
authors.forename: Ryozi
authors.initials: R
authors.lastname: Yamada
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Tabei
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Koizumi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yagi
mesh_terms: D000368:Aged; D000381:Agraphia / Q000175:diagnosis / Q000209:etiology*; D001930:Brain Injuries / Q000150:complications* / Q000209:etiology / Q000473:pathology; D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D004411:Dyslexia, Acquired / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D009483:Neuropsychological Tests; D010296:Parietal Lobe / Q000473:pathology*; D012189:Retrospective Studies