Apraxia of speech with phonological alexia and agraphia following resection of the left middle precentral gyrus: illustrative case.

Apraxia of speech is a disorder of speech-motor planning in which articulation is effortful and error-prone despite normal strength of the articulators. Phonological alexia and agraphia are disorders of reading and writing disproportionately affecting unfamiliar words. These disorders are almost always accompanied by aphasia. A 36-year-old woman underwent resection of a grade IV astrocytoma based in the left middle precentral gyrus, including a cortical site associated with speech arrest during electrocortical stimulation mapping. Following surgery, she exhibited moderate apraxia of speech and difficulty with reading and spelling, both of which improved but persisted 6 months after surgery. A battery of speech and language assessments was administered, revealing preserved comprehension, naming, cognition, and orofacial praxis, with largely isolated deficits in speech-motor planning and the spelling and reading of nonwords. This case describes a specific constellation of speech-motor and written language symptoms-apraxia of speech, phonological agraphia, and phonological alexia in the absence of aphasia-which the authors theorize may be attributable to disruption of a single process of "motor-phonological sequencing." The middle precentral gyrus may play an important role in the planning of motorically complex phonological sequences for production, independent of output modality.

Citation

Deborah F Levy, Alexander B Silva, Terri L Scott, Jessie R Liu, Sarah Harper, Lingyun Zhao, Patrick W Hullett, Garret Kurteff, Stephen M Wilson, Matthew K Leonard, Edward F Chang. Apraxia of speech with phonological alexia and agraphia following resection of the left middle precentral gyrus: illustrative case. Journal of neurosurgery. Case lessons. 2023 Mar 27;5(13)

PMID: 37014023

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