In this report, we describe a case of pathological mirror writing involving a right-handed Korean patient with a left basal ganglia lesion. Using his intact left hand, he always initiated writing from the right margin, and each grapheme was written as its mirror image with intact writing sequences. However, with external verbal ('Please write rightwards from here') and visual (rightward arrow) cues, he wrote normally from the left edge of the paper. This finding confirms that people with basal ganglia lesions compensate for a malfunction by relying on external cues to guide movements. A particularly interesting observation is that, with only a verbal cue to write rightwards, writing initiated from the left margin produced a vertical script with mirror writing. This phenomenon is noteworthy because it can be observed only in languages with a top-to-bottom writing system.
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Department of Rehabilitation Medicine and Graduate Program in Speech and Language Pathology, Yonsei University College of Medicine, Seoul, South Korea;