Pure dysgraphia with relative sparing of lower-case writing

We describe the cognitive analysis of a patient with acquired pure dysgraphia. She presented a peculiar dissociation between lower- and upper-case handwriting: lower-case writing was relatively spared and showed a significant superiority of words versus nonwords. Upper-case writing and oral spelling did not show lexical effects, but were affected by item length. In all modalities errors consisted mainly of single graphemic substitutions, deletions, insertions and transpositions, resulting in legal or illegal nonwords, and showed a similar distribution across letter positions. These findings were suggestive of an impairment of the graphemic output buffer, which however revealed itself to different degrees in the two handwriting styles.