Increased writing activity in a 70 year old, right handed man presenting with a history of alcohol misuse and maturity onset diabetes is reported. Brain CT disclosed corticosubcortical atrophy and 99mTc-HMPAO SPECT disclosed severe bilateral frontal hypoperfusion more prominent on the right. The patient's neuropsychological symptomatology consisted of severe (verbal) aspontaneity, intermittent utilisation behaviour, and pronounced increased writing activity, which mainly consisted of a perseverative, micrographic written reproduction of visually or verbally perceived language fragments. Several neurological causes of increased writing activity and the equivocal terminology met in the medical literature are reviewed. A distinction between hypergraphia and automatic writing behaviour is proposed. It is concluded that our patient's increased writing activity may be characterised as automatic writing behaviour.
Adult rhabdomyomas of the head and neck are uncommon benign skeletal muscle tumors. Only a few cases occurring in the pharyngeal wall have been described in the world literature. We present a case of recurrent bilateral rhabdomyomas in the pharynx and discuss the clinicopathological features of this lesion, comparing it to those of other neoplasms from which it must be differentiated. To our knowledge, bilaterality of this type of lesion has not been described previously. Although adult rhabdomyomas have a distinct histology, they often are mistaken for a variety of other lesions, particularly granular cell tumor.
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