Right-sided neglect influences the writing of Kanji: A case study

Neglect is the failure to report, respond, or orient to novel or meaningful stimuli presented to the side opposite a brain lesion. Here we describe the case of a 73-year-old woman who experienced a writing deficit in the right-sided component of Kanji letters (morphograms) of the Japanese language. Magnetic resonance imaging of the brain showed an infarction in the left middle temporal and occipital gyrus. The patient wrote recognizable, well-formed but paragraphic Kanji letters in both spontaneous and dictated writing. Most letters are composed of two elements: "hen" (left) and "tsukuri" (right). Neographism in tsukuri was her most frequent error. When she was instructed to answer orally hen and tsukuri, she made more mistakes related to tsukuri than to hen. Unilateral spatial neglect in memory or imagery was reported. We concluded that unilaterally disrupted processing of internal representations affected the writing of Kanji letters in this patient.