Hi

I think the answer to your question depends a bit on what else the patient can or cannot do. If he can write in general, but has a severe aphasia, then it is rather seldom I'd say. But the example you gave is a type of writing that is relatively automatized. So, before answering the question, it is important to know what else he can and cannot do: write words, sentences, but not read them?

Aphasias/dysphasias may occur following brain injury. The manifestation will reflect the location of brain impacted whatever the cause (e.g., stroke, or brain injury). The description above is incomplete. Based on the description, I would expect the lesion/injury to involve the left temporoparietal area. If his speech and writing are normal (not clear from the description) , then the angular gyrus was not affected. However, you should be able to see this on MRI. I expect the patient may have injury to the conduction fibers, as the description above leads one to think you did not encounter any problems suggestive of Broca or Wernicke's area involvement.

Thank you for your responses.

I apologize for not providing a complete description of his speech-language diagnoses/abilities. The location of the patient's single lesion is in fact in the left temporoparietal area. The initial diagnoses was mild Broca's aphasia/anomia following his lesion 4 years ago. He is generally still able to write with accuracy, though at a significantly slower rate. He can read complex sentences and paragraphs with some word substitutions ("he" for "the) though he quickly self-corrects. He answers reading comprehension questions with 90% accuracy, and he is generally able to maintain topic focus and engage in meaningful dialogue. It was in light of his abilities in both expressive and receptive language modalities that the event described in my post intrigued me, as it does not seem to be concurrent with his overall communicative abilities. For example, when writing names of spouses, doctors, or hospitals, he is able to correctly verbalize the item while simultaneously writing it. However, when writing numbers of any kind (phone numbers, SSNs, etc.) this same pattern of breakdown appears as described above. I would be interested to find out what literature exists on the underlying mechanisms of breakdown for processing numbers, in light of comparably intact language processing abilities for left-hemisphere damaged patients.

I am not completely sure, but could this be a form of acalculia?

It certainly seems like it to me, though the official speech pathology report makes no diagnosis of acalculia. Thank you for the suggestion. I think I need to dig deeper into his medical files from the hospital where he received acute care, as the most recent files do not address this number difficulty. I would be surprised if a diagnosis of some kind pertaining to his difficulties with numbers was not reached. If his earlier reports likewise don't mention the breakdown in numeric verbal production, it would seem that either a crucial facet of his impairment was not brought to light, or somehow it developed recently, though I am unsure as to how this would happen.

I think it is not unlikely that something like acaculia goes unnoticed. Not sure for the US, but here (Germany), it isn't something that is in the standard diagnosis package...

I am unfamiliar with any sort of treatment plan/component of a treatment utilized to target acaculia. Do you have any recommendations about clinical intervention procedures for this facet of communicative impairment, or is your experience that the specific treatments that target this behavior are judged to be less important than treatments that address the more global aspects of aphasia that can be concomitant with acaculia? Thanks so much for your feedback.

actually, I do not have any experience in treating that, sorry, so no recommendation there...