[Neuropsychiatric background of severe drawing disturbances]

Drawing ability is a primary human skill, which first appeared in the paleolithic art. In spite of this fact, neuropsychology of drawing has been a neglected subject of brain research. In the Crisis Intervention Department at the Budapest Social Center (Hungary), five patients with local brain lesions were identified, who had severe drawing disturbances. This was defined when the form representation in the House-Tree-Person drawing test was was not maintained and was associated with altered figure-perception. Patients were underwent detailed neurological, mental and neuropsychological assessment. Computer tomography of the head was performed at different hospitals in Budapest. House-Tree-Person drawing test was used, which was complemented with copy and visual memory tasks (with Rey-picture), as well as with spontaneous drawing, if it was necessary. Severe drawing disturbances were found in patients with severe right frontal, right temporo-parietal, diffuse right fronto-parieto-temporal, left occipito-temporal lesions and with bilateral basal ganglia lesions with enlarged ventriculi. Impairment of copying figures was sometimes seen without associated impairment of drawing on verbal instructions. Visual memory, visual images in long-term memory, visual analysis, the ability of adequat placement of parts into the whole representation, visuomotor transfer and perhaps the motor drawing programs could be altered separately. Severe drawing disturbance might occur with perfectly maintained writing capabilities. The data indicated that drawing ability requires the intact activity of nearly the whole brain, but it also includes several subfunctions, which could be altered relatively separately.