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Transient Automatic Writing Behavior following a Left Inferior Capsular Genu Infarction
Keisuke Suzuki1, Tomoyuki Miyamoto, Masayuki Miyamoto
1Department of Neurology, Dokkyo Medical University, Tochigi, Japan.
Case Reports in Neurology
|September 18, 2010
Summary
A stroke caused unusual writing behavior in a 79-year-old woman, characterized by increased, perseverative writing. This symptom, linked to frontal-subcortical circuit disconnection, resolved within weeks.
Area of Science:
- Neurology
- Neuroimaging
- Neuropsychology
Background:
- A 79-year-old woman presented with decreased spontaneity, a common symptom of neurological impairment.
- Brain MRI revealed a left inferior capsular genu infarction, indicating a focal brain injury.
- Technetium-99m ethylcysteinate dimer (99mTc-ECD) SPECT showed left-dominant hypoperfusion in the basal ganglia and frontal lobe.
Observation:
- The patient exhibited abulia (lack of motivation) and significantly increased writing activity.
- Writing was characterized by perseveration, with legible but repetitive content.
- No motor or sensory deficits were observed, highlighting a specific behavioral dissociation.
Findings:
- The patient's writing behavior, resembling automatic writing more than hypergraphia, resolved by day 21.
- A dissociation between speech and writing functions was noted.
- The clinical presentation suggests a disconnection within the frontal-subcortical circuit.
Implications:
- This case highlights how focal brain lesions can lead to specific behavioral changes, such as motor perseveration in writing.
- Understanding frontal-subcortical circuit connectivity is crucial for diagnosing and treating disorders of spontaneity and behavior.
- The transient nature of the writing abnormality offers insights into brain plasticity and recovery mechanisms.
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