title: Apraxic agraphia following bithalamic damage.
abstract: OBJECTIVE
  Apraxic agraphia (AA) is a peripheral writing disorder generally considered to result from a causative lesion in the parietal and/or prefrontal lobe of the language dominant hemisphere (De Smet, Engelborghs, Paquier, De Deyn, & Mariën, 2011). De Smet et al. (2011), however, confirmed that AA might be associated with lesions outside the typical language areas such as the cerebellum or the thalamus. We report a 32-year-old ambidextrous patient with a left frontal lobectomy who following bilateral thalamic damage developed AA.
  
  
  METHODS
  Detailed neurolinguistic and neurocognitive test results were obtained after resection of an extensive left frontal lobe tumour by means of a set of standardised tests. Repeated investigations were performed after a bithalamic stroke. Functional imaging was performed by means of quantified SPECT.
  
  
  RESULTS
  Normal neurolinguistic test results were obtained after tumour resection. Neurocognitive test results, however, showed a dysexecutive syndrome and frontal behavioural deficits, including response inhibition. AA occurred after a bithalamic stroke while non-handwriting written language skills, such as typing, were normal. Quantified SPECT showed a significant bifrontal hypoperfusion.
  
  
  CONCLUSIONS
  Neurolinguistic follow-up findings and SPECT evidence in this unique patient with bithalamic damage for the first time indicate that AA in the alphabetic script may result from diaschisis affecting the frontal writing centre. The findings suggest that the thalamus is critically implicated in the neural network subserving graphomotor processing.
authors: Department of Clinical and Experimental Neurolinguistics, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium; Cepos, Rehabilitation Centre, Rooienberg 21, B-2570 Duffel, Belgium.
authors: Dorien
authors: D
authors: Vandenborre
authors: Department of Clinical and Experimental Neurolinguistics, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium.
authors: Kim
authors: K
authors: van Dun
authors: Department of Clinical and Experimental Neurolinguistics, Vrije Universiteit Brussel, Pleinlaan 2, B-1050 Brussels, Belgium; Department of Neurology & Memory Clinic, ZNA Middelheim General Hospital, Lindendreef 1, B-2020 Antwerp, Belgium. Electronic address: peter.marien5@telenet.be.
authors: Peter
authors: P
authors: Mariën
mesh_terms: D000328:Adult; D000381:Agraphia / Q000503:physiopathology*; D001072:Apraxias / Q000503:physiopathology*; D006236:Handwriting; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D013788:Thalamus / Q000503:physiopathology*
keywords: Apraxic agraphia; Bithalamic stroke