[Dissociated preservation of written expression in aphasia with recurrent utterances]

In a female patient, aphasia with recurrent utterances resulted from a double lesion of the left hemisphere, located in the base of the third frontal gyrus and the upper temporal gyri. Predominant in the fluent oral expression was a repeated neologism of which the patient was unaware. The written expression, efficient for lexical entities, was devoid of syntax and had the features of phonological agraphia. Both orally and in written words comprehension was satisfactory but syntactic comprehension was deficient. The stereotyped verbal behaviour could be due to dysfunction of the phonemic programmer. Rupture of the audi-phonatory loop, confirmed by degradation of the verbal working, memory, made this dysfunction worse and accounted for the anosognosia. The participation of the right hemisphere and of the preserved left hemispheric structures in the persistence of various language activities are discussed.