Pure Agraphia Associated with a Frontal Meningioma on Left Superior Frontal Gyrus

Abstract

Background: The existence of cerebral area specifically involved in coding for writing movements in the left middle frontal gyrus is a matter of debate. We present a rare case of pure agraphia associated with a left frontal meningioma. The location of the lesion associated with this disorder could help to feed this debate. Method: We report a case of pure agraphia in a 69-year-old man. The patient had a writing disorder evolving over several months with a dominant, left frontal lesion. On neuropsychological evaluation, the writing difficulties were present whatever the nature of the writing (spontaneous, dictation, coping). The writing disorder was isolated, with no features of aphasia, alexia or limb apraxia. Phonological and lexical processing was preserved. The imaging showed a probable frontal meningioma restricted to the foot of the first and second left frontal circumvolutions (MNI coordinates /barycenter of the lesion: x=-19.8, y=1.5, z=52.2). Results: The patient was operated and the whole lesion was removed. After surgical resection, the patient’s writing disorder improved. Other components of language assessed were the same as before the surgery and showed no disturbances. The pathological study concluded on an OMS grade II atypical meningioma. Conclusion: We think that the disorder presented by our patient was related to the disturbance of the frontal graphemic center located in the Exner area. Here, we describe and analyze his condition through a neuro-anatomical and a cognitive approach.