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NEUROLOGY 1997;49:946-952
© 1997 American Academy of Neurology

Frontal pure agraphia for kanji or kana: Dissociation between morphology and phonology

Yasuhisa Sakurai, MD PhD, Kiichiro Matsumura, MD PhD, Takeshi Iwatsubo, MD PhD and Toshimitsu Momose, MD PhD

From the Department of Neurology (Dr. Sakurai), Mitsui Memorial Hospital, and Department of Neurology, School of Medicine, University of Tokyo, Tokyo; Department of Neurology (Drs. Sakurai and Matsumura), Shimoshidzu National Hospital, Chiba; Department of Neurology (Dr. Matsumara), Teikyo University School of Medicine, Tokyo; Department of Neuropathology and Neuroscience (Dr. Iwatsubo), Faculty of Pharmaceutical Sciences, University of Tokyo, Tokyo; and Department of Radiology (Dr. Momose), School of Medicine, University of Tokyo, Tokyo, Japan.

Address correspondence and reprint requests to Dr. Yasuhisa Sakurai, Department of Neurology, Mitsui Memorial Hospital, 1, Kanda-Izumi-cho, Chiyodaku, Tokyo 101, Japan.

We present two patients with frontal pure agraphia more impaired for either kanji or kana (two separate writing systems for the Japanese language). The lesion of patient 1 (preferentially disturbed for kanji) was restricted to the foot of the middle frontal gyrus and the adjacent anterior precentral gyrus, whereas the lesion of patient 2 (preferentially disturbed for kana) included the posterior two thirds of the middle frontal gyrus. Both patients made agraphic errors (impaired recall) for kanji and agraphic or paragraphic errors (changing into other symbols) for kana. The double dissociation and the difference in types of errors between kanji writing and kana writing suggests that there are two pathways involved in writing, i.e., a morphologic route and a phonologic route. We concluded that damage to the morphologic route may yield agraphia for kanji and that damage to the phonologic route may yield agraphia for kana.

Received February 12, 1997. Accepted in final form April 21, 1997.




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