A Case of Nonalcoholic Marchiafava-Bignami Disease with Left-Right Differential Agraphia of Chinese Characters

摘要

We report a 68-year-old right-handed female who was admitted to our hospital complaining chiefly of incontinence and decreased activity. Her brain images showed characteristics of Marchiafava-Bignami disease, such as symmetrical abnormal signals localized in the corpus callosum. The patient had no drinking habits. Her past medical history included total gastric resection to treat gastric cancer. On hospital admission she was markedly underweight. This appeared to be a rare case of Marchiafava-Bignami disease not attributable to heavy drinking and occurring in a state of malnutrition. Evaluation of callosal dissociation symptoms produced findings indicative of such symptoms. She showed a marked difficulty in writing dictated single words and short sentences in Japanese alphabetic characters, especially with her left hand. In contrast, writing dictated words in Chinese characters (also used in written Japanese) was affected in both hands, with different types of dysgraphia seen in the right and left hands. The agraphia in the left hand seen in this patient appears to have occurred as a result of the language faculty of the left hemisphere failing to be transmitted to the right brain, while agraphia in the right hand may have occurred as a result of spatial processing information in the right hemisphere failing to be transmitted to the left hemisphere.