PubMed · 1922836
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J C Horton, W F Hoyt. 1991. Alexia without agraphia.. https://doi.org/10.1212/wnl.41.10.1708-d
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Phonological agraphia is a neurolinguistically specific profile of spelling impairment. It is characterized by an impairment in spelling pronounceable pseudowords ('sild') and by an impairment in spelling real words related to their familiarity, length, and often, part of speech (Shallice, 1981; Roeltgen, 1985; Bub & Chertkow, 1988). We report two cases of phonological agraphia, each with a different lesion profile. Analysis of the small number of published cases that include lesion data, plus our own cases, suggests that phonological agraphia can be produced by lesions in a wide range of perisylvian cortical regions that have in common some role in central phonological processes.
Repetition, reading, confrontation naming, and oral and written spelling were studied in a 57 year-old man with a left hemisphere tumour. These tasks were repeated over a period of two weeks when the patient was being treated for brain oedema prior and subsequent to neurosurgical intervention. In the context of intact repetition and good reading, the most striking finding was a significant qualitative and quantitative discrepancy between oral and written spelling, with the latter task more severely affected. The pattern on oral spelling was that of lexical (or surface) agraphia. On written output, however, orthographic errors predominated. The relatively greater impairment of written spelling was not secondary to a motoric or visuo-spatial deficit. The observed patterns are not easily accommodated by current models of writing.
A 49-year-old right-handed man presented with a severe impairment of motor speech output aphemia. Initially, he could make grunting sounds, but was otherwise mute. There was no disturbance of comprehension, and he preferred to communicate by writing. Writing was agrammatic with lexical errors and mispellings which improved with the speech disturbance. The writing abnormalities of aphemics emphasize the aphasic nature of this speech abnormality.