Ictal multicomponent agraphia in left temporal lobe epilepsy

Abstract

A 58-year-old woman with a clinical diagnosis of temporal lobe epilepsy characterized by episodes of disorientation and derealization followed by aphasia tried to write sentences during a seizure. Instead, she drew random figures (figure 1). External standard MRI was reported normal; however, a nonenhancing left amygdala lesion was identified on our 3T epilepsy protocol MRI (figure 2). This drawing emphasizes ictal multicomponent agraphia characterized by impaired allographic storage with expected accompanying aphasia. 1 Although symbolic graphic language is impaired, non-language-based symbolic graphic production remains intact. This suggests posterior temporal/temporo-parietal junction involvement during seizure spread. 2 Figure 1 Illustration According to the patient, "Couldn't think of letters to write-just shapes to start."