Alexia with agraphia due to the left posterior inferior temporal lobe lesion—Neuropsychological analysis and its pathogenetic mechanisms

doi:10.1016/0093-934X(88)90070-3

Brain and Language

Volume 33, Issue 2, March 1988, Pages 296-310

https://doi.org/10.1016/0093-934X(88)90070-3 Get rights and content

Abstract

We report three cases of alexia with agraphia due to the left posterior inferior temporal lesions. In Case 1, the reading disability was more prominent in the use of Kana than in the use of Kanji, which is similar to previously reported cases of alexia with agraphia due to angular gyrus lesion. In Cases 2 and 3, by contrast, the reading disability was more prominent in the use of Kanji than in the use of Kana. In spontaneous writing and dictation, the disability was more pronounced in the use of Kanji compared with the use of Kana. In each of the three cases, the CT scan and positron emission tomography showed a localized lesion in the lower part of the left posterior temporal lobe. A typical form of an alexia with agraphia could be caused not only by the left angular lesion but also by the left posterior inferior temporal lesion. We discuss the neuropsychological analysis and pathogenetic mechanisms of alexia with agraphia due to the left posterior inferior temporal lesion in the comparison of alexia with agraphia caused by the left angular lesion.

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Visual words and faces activate similar networks but with complementary hemispheric asymmetries, faces being lateralized to the right and words to the left. A recent theory proposes that this reflects developmental competition between visual word and face processing. We investigated whether this results in an inverse correlation between the degree of lateralization of visual word and face activation in the fusiform gyri. 26 literate right-handed healthy adults underwent functional MRI with face and word localizers. We derived lateralization indices for cluster size and peak responses for word and face activity in left and right fusiform gyri, and correlated these across subjects. A secondary analysis examined all face- and word-selective voxels in the inferior occipitotemporal cortex. No negative correlations were found. There were positive correlations for the peak MR response between word and face activity within the left hemisphere, and between word activity in the left visual word form area and face activity in the right fusiform face area. The face lateralization index was positively rather than negatively correlated with the word index. In summary, we do not find a complementary relationship between visual word and face lateralization across subjects. The significance of the positive correlations is unclear: some may reflect the influences of general factors such as attention, but others may point to other factors that influence lateralization of function.
Distinct role of spatial frequency in dissociative reading of ideograms and phonograms: An fMRI study
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It has been proposed that distinct neural circuits are activated by reading Japanese ideograms (Kanji) and phonograms (Kana). By measuring high-density event-related potentials, we recently reported that spatial frequency (SF) information is responsible for the dissociation between Kanji and Kana reading. In particular, we found close links between Kana and low SF (LSF) information and between Kanji and high SF (HSF) information. However, it remains unclear which brain regions contribute to this dissociation. To determine this, we performed functional magnetic resonance imaging while presenting unfiltered or spatially filtered Kanji and Kana word stimuli to healthy native Japanese subjects. Fourier analysis revealed that Kanji and Kana stimuli were characterized by HSF and LSF information, respectively. When presented with either type of unfiltered stimulus (Kanji or Kana), the bilateral inferior temporal (IT, BA 37) regions were activated compared to the resting condition. Kana but not Kanji reading also activated the bilateral inferior parietal lobules (IPL, BA 40). When we compared Kanji and Kana reading directly, the left IT region was significantly activated by Kanji reading, while significant activation of the left IPL was observed during Kana reading. In response to filtered HSF stimuli, the Kanji reading minus Kana reading comparison revealed significant activation of the left IT region but not the left IPL. Conversely, significant activation of the left IPL but not the left IT region occurred in the Kana reading minus Kanji reading comparison for filtered LSF stimuli. These results suggest that Kanji and Kana engage a relatively overlapping network, within which the left IT is more involved in Kanji processing, while the left IPL contributes more to Kana processing. The preferential engagements of these brain regions could reflect the close links between Kana and LSF information, and between Kanji and HSF information. Therefore, this study provides further evidence that SF contributes to the dissociation between Kanji and Kana reading.
Differential roles of spatial frequency on reading processes for ideograms and phonograms: A high-density ERP study
2012, Neuroscience Research
Citation Excerpt :
Previous studies have proposed distinct neural circuits underlying the reading systems of Kanji and Kana: the ventral orthographic and dorsal phonological routes. This view is supported by the findings from previously mentioned neuropsychological studies and neuroimaging studies with high spatial resolution (Iwata, 1984; Kawahata et al., 1988; Thuy et al., 2004; Sakurai et al., 2008). Similarly, one study reported that inducing transient functional suppression of the left posterior IT cortex using repetitive transcranial magnetic stimulation disturbed the retrieval of visual graphic representations of Kanji (Ueki et al., 2006).
The neural substrate of the dissociation between reading Japanese ideograms (Kanji) and phonograms (Kana) is currently unclear. To test whether spatial frequency (SF) information is responsible for this phenomenon, we recorded high-density event-related potentials (ERPs) with unfiltered or spatially filtered word stimuli in Japanese-speaking subjects. Kanji (early-learned, late-learned), Kana (word, non-word), and scrambled characters served as stimuli. Fourier analysis revealed that Kanji and Kana were characterized by high-SF (HSF) and low-SF (LSF) information, respectively. In ERPs with unfiltered stimuli, bilateral occipital P100, left occipitotemporal N170 and fronto-central N400 were elicited. Scrambled characters did not evoke left-lateralized N170 or clear N400. Under the LSF condition, P100 and N170 latencies for Kanji were significantly longer than those for Kana. In the HSF condition, P100 and N170 latencies for late-learned Kanji were significantly longer than those for early-learned Kanji. There was no significant difference in the N400 between Kanji and Kana in both SF conditions. These results suggest that early visual responses, but not the semantic component, are influenced by SF. This indicates a close link between Kana and LSF information, and between Kanji and HSF information. The differential effects of SF could underlie the neural basis of the differences between Kanji and Kana reading.
Temporal lobe epilepsy manifesting as alexia with agraphia for kanji
2011, Epilepsy and Behavior
Citation Excerpt :
The Japanese writing system includes ideograms (kanji) and syllabograms (kana). In patients with left posteroinferior temporal lesions, reading and writing of ideograms are selectively disturbed [2–7]. We herein describe a patient showing alexia with agraphia for kanji caused by temporal lobe epilepsy.
Alexia with agraphia results from lesions of the left angular gyrus or the left posteroinferior temporal lobe. In Japanese or Korean persons, lesions of the latter cause alexia with agraphia for ideograms. We describe a case of alexia with agraphia for kanji (Japanese ideograms) caused by temporal lobe epilepsy. After generalized convulsions, a 32-year-old man noticed that he had difficulty in reading and writing kanji, although he could read and write kana (Japanese syllabograms). His EEG showed frequent sharp waves on the left occipitotemporal region. MRI of the brain revealed a hyperintense lesion on the left hippocampus. Single-photon-emission computed tomography revealed marked hyperperfusion at the left hippocampus and the left posteroinferior temporal cortex. Antiepileptic drugs improved his alexia with agraphia for kanji. This is the first report describing alexia with agraphia for kanji caused by temporal lobe epilepsy.
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2011, NeuroImage
Citation Excerpt :
Further studies need to be carried out which modulate the reading task phonological/semantic demands and then assess the degree to which this modulates activation overlap with spelling in order to confirm this. Many studies have reported that lesions to the left occipitotemporal cortex region are associated with spelling impairments (Kawahata et al., 1988; Rapp and Caramazza, 1997; Rapcsak and Beeson, 2004; Hillis et al., 2005; Tsapkini and Rapp, 2009). Specifically, lesions to this region have been associated with phonologically plausible errors in irregular word spelling, which suggests that it plays a critical role in output orthographic lexical processing (Rapcsak and Beeson, 2004).
In this study we employed a novel technique to examine the neural basis of written spelling by having subjects touch-type single words on an fMRI compatible QWERTY keyboard. Additionally, in the same group of participants we determined if task-related signal changes associated with typed spelling were also co-localized with or separate from those for reading. Of particular interest were the left inferior frontal gyrus, left inferior parietal lobe as well as an area in the left occipitotemporal cortex termed the Visual Word Form Area (VWFA), each of which have been associated with both spelling and reading. Our results revealed that typed spelling was associated with a left hemisphere network of regions which included the inferior frontal gyrus, intraparietal sulcus, inferior temporal/fusiform gyrus, as well as a region in the superior/middle frontal gyrus, near Exner's area. A conjunction analysis of activation associated with spelling and reading revealed a significant overlap in the left inferior frontal gyrus and occipitotemporal cortex. Interestingly, within the occipitotemporal cortex just lateral and superior to the VWFA we identified an area that was selectively associated with spelling, as revealed by a direct comparison of the two tasks. These results demonstrate that typed spelling activates a predominantly left hemisphere network, a subset of which is functionally relevant to both spelling and reading. Further analysis revealed that the left occipitotemporal cortex contains regions with both conjoint and dissociable patterns of activation for spelling and reading.
Disorders of higher visual processing
2011, Handbook of Clinical Neurology
Citation Excerpt :
In this disorder both reading and writing are impaired but oral and auditory language is preserved. Alexia with agraphia is associated with lesions of the left angular gyrus (Dejerine, 1892; Benson, 1985) (Fig. 9.6) or sometimes the adjacent temporoparietal junction (Kawahata and Nagata, 1988; Paquier et al., 2006). It is more likely a linguistic than perceptual disorder: its characteristics suggest a deep dyslexia with deep dysgraphia (see below) (Glosser and Friedman, 1990; Cohen et al., 2000; Sheldon et al., 2008).
A significant proportion of human cortex is involved in visual processing. Cerebral regions beyond striate cortex show specialization for specific stimulus properties: damage to these regions leads to syndromes that also reflect this specialization. These syndromes can be grouped into two broad categories. In the ventral group, there is damage to medial occipitotemporal structures that participate in object identification and recognition. This can result in a variety of syndromes, including achromatopsia, general visual object agnosia, or more selective object recognition deficits such as prosopagnosia, alexia, and certain forms of topographagnosia, such as landmark agnosia. In the second, dorsal group, there is damage to lateral occipitoparietal structures that participate in visuospatial processing and localization. Patients with such damage may have akinetopsia (impaired motion processing), various components of Bálint syndrome, or astereopsis. Finally, it is also possible to find patients in whom residual visual processing is evident despite damage to the geniculostriate pathway; this blindsight may reflect residual function of either subcortical structures, such as the superior colliculus, or alternate afferent routes to surviving extrastriate cortex.

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Alexia with agraphia due to the left posterior inferior temporal lobe lesion—Neuropsychological analysis and its pathogenetic mechanisms

Abstract

Comprehension in alexias

Brain

Sur un cas de cecite verbale avec agraphie, suivi d'autopsie

Memories de la Societe de Biologie

Alexia

Disconnexion syndromes in animals and man

Brain

Disconnexion syndromes in animals and man

Brain

Kanji versus Kana

Neuropsychological correlations of the Japanese writing system

Trends in Neurosciences

Alexia with agraphia due to the left posterior inferior temporal lesion—Cerebral blood flow and oxygen utilization by positron emission CT

Japanese Journal of Neuropsychology (Tokyo)