Left Subcortical Infarction Presenting Pure Agraphia

We report a man who exhibited pure agraphia after suffering a left subcortical infarction involving part of the thalamus and the basal ganglia. His writing difficulty was characterized by stopping, letter omission, and substitution in spontaneous writing and writing to dictation, but he was able to copy normally. Decreased perfusion in the left frontal lobe and temporal cortex was noted on brain single-photon-emission computed tomography . This patient's agraphia persisted at follow-up 52 days later. We suggest that the subcortical lesion in this patient caused pure agraphia secondary to diaschisis of the interconnected cortical area.