Phonological agraphia following a focal anterior insulo-opercular infarction

Following a unique infarction, restricted to the left anterior insula and t he adjacent part of the intrasylvian frontal opercular cortex, an 83-year-o ld right-handed patient acutely developed a severe speech disorder that evo lved into mere mutism within a few hours. After rapid recovery from mutism, oral language was characterized by severe apraxia of speech. In-depth lang uage investigations further disclosed an isolated, highly selective disturb ance of the spelling system (phonological agraphia) which resolved rapidly. One year after onset of neurological symptoms, the apraxia of speech had a lmost completely receded. The anatomoclinical findings in this first repres entative of pure and nearly isolated phonological agraphia complement previ ous neuroanatomical and neurolinguistic accounts of phonological agraphia. The data not only seem to enrich current insights in the anatomical locus f or phonological agraphia, they also seem to contribute to a further delinea tion of the insular role in phonologically mediated aphasic manifestations. (C) 2001 Elsevier Science Ltd. All rights reserved.