Micrographia due to focal cerebral lesions as Seen in the dysarthria‐clumsy hand syndrome

Abstract

Five patients with dysarthria-clumsy hand syndrome developed micrographia. Four had lacunar infarctions involving the putamen or the genu of the internal capsule; the fifth patient had a small hemorrhage in the putamen. Micrographia may be a sign of focal cerebral disease, and basal ganglia dysfunction may be involved in the supratentorial dysarthria-clumsy hand syndrome.

Micrographia secondary to lenticular lesions

“…Although experimental lesions of corticospinal tracts may lead to impairment of fine motor skills, the involvement of the internal capsule was minor compared to the striatal lesions and could not account for the isolated modification in handwriting. Consistent with our findings, most of the recent reports of micrographia secondary to focal lesions involved the lenticular nucleus (see Pullicino et al,2 references) or the internal capsule3 contralateral to the dominant hand. Some reports also described micrographia due to a demyelinating lesion of the left parietal lobe4 after infarct of the left thalamus5 and as a consequence of cerebral deep venous thrombosis 6…”

Fast micrographia and pallidal pathology

“…Micrographia, signifying abnormally small handwriting, was first described as a neurological symptom or sign by Pick1 in 1903, in a patient with a syphilitic infarct of the left thalamus. He recognised several other possible causes, but excluded “the fine, dainty style sometimes observed in the handwriting of the learned.” Since then, micrographia has occasionally been associated with thalamic and putaminal and other lesions,2–7 a parietal white matter lesion in multiple sclerosis,8 and a unilateral lesion of the lentiform nucleus 9, 10. However, micrographia is classically associated with Parkinson's disease (PD).…”

Post Graphemic Impairments Of Writing: The Case Of Micrographia

“…Since Pick's seminal observation (1903) of isolated MG following a syphilitic infarct of the left thalamus, this symptom has been reported following a lesion different from the condition usually linked to PD. MG has been described following lesions, mostly of vascular origin, of the left basal ganglia including putamen, globus pallidus, thalamus or substantia nigra (Scolding and Lees, 1994;Pullicino et al, 1994;Kim et al,1998;Derkinderen et al, 2002;Nakamura et al, 2003;Troyer et al, 2004), sometimes as the only clinical manifestation (Martinez-Vila et al, 1988), in other cases with concomitant mild deficits of expressive language and verbal memory (Pullicino et al, 1994), attentional disorders (Troyer et al, 2004) or focal dystonia (Münchau et al, 2000); a pattern of MG and hypophonia has been described in a case of extensive cerebral vein thrombosis (Murray et al, 2000) or associated to the dysarthria-clumsy hand syndrome (Noda et al, 1994). Finally, MG has been reported following a parietal lobe lesion in Multiple Sclerosis (Scolding and Lees, 1994).…”