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A History of Neuropsychology


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Charcot used word blindness (alexia) and agraphia to illustrate 2 of the partial forms of aphasia [31].

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      Alexia with and without Agraphia

      Jules Dejerine (1849–1917) is linked to syndromes of alexia with agraphia and alexia without agraphia. His seminal work occurred at the Bicêtre hospital in Paris, and later he became the third person to hold the chair in Clinical Diseases of the Nervous System at the Salpêtrière hospital.

      When one gives him a newspaper or a written phrase, he looks at the newspaper or the paper for a moment, then faces the examiner, stating, “I do not understand.” The same for letters of the alphabet, which he could scarcely name.… When one tells the patient to write, he holds the pen or pencil quite awkwardly … and if sometimes he wishes to write spontaneously, to dictation or copy, he always writes [only] his name. [34].

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      His spoken language is very correct, even carefully selected; he always uses appropriate terms and shows no trace of paraphasia. … The patient understands perfectly all that one says to him. … Writing spontaneously and to dictation is perfectly preserved. … Spontaneously, the patient writes as well as he speaks. In comparing the many writing specimens that I had him write, one notices no mistakes, no spelling error, no transposition of letters. … Writing to dictation is executed equally easily and fluently, but reading what the patient has written is absolutely impossible. Here it is indeed a question of a case of absolutely pure word blindness. The patient recognizes not a letter, not a word except, however, his name.” [35].

      The second stroke caused slurred speech and right-sided weakness. Although he soon regained his strength, his speech contained naming errors, and he could not write (Fig. 4d). He died soon after the second stroke, and the autopsy showed 2 lesions (Fig. 3b). Dejerine summarized the case as follows (pp 83–84; translation from [3]):

      During the first phase, which lasted 4 years, the patient presented the purest clinical picture that one can imagine of … pure word blindness without any alteration in spontaneous writing or [writing] to dictation. During the second phase, which lasted only 10 days, complete agraphia with paraphasia came to complicate word blindness. In this second phase, the clinical picture then corresponded to … word blindness with marked alteration of writing.