Descriptive Psychopathology: The Signs and Symptoms of ...

187 Chapter 7: Disturbances of motor functionThe consultant diagnosed post-ictal catatonia following a period of statusepilepticus and prescribed lorazepam. Eight milligrams daily resolved thecatatonia and the patient was discharged on a new anticonvulsant drugregime.Rare motor syndromes mistaken for conversion hysteriaApraxic agraphiaApraxic agraphia is a language-related motor disturbance. “Pure” apraxic agraphiais the inability to construct letters in the absence of a disturbance in spelling,reading, or substantial praxis or visual–constructional difficulties. 154 In itsmildest form, handwriting is deteriorated but legible. Cursive writing may belost, the patient reduced to child-like printing. The alignment of the writing mayalso be askew. Apraxic agraphia is associated with lesions in the left superiorparietal lobe 155 Patient 7.12 illustrates.Patient 7.12 156A 78-year-old, right-handed man, referred for a follow-up evaluation of adepression-like syndrome, was in his usual state of health until age 61, whenhe had what was described as a “transient ischemic attack”. The patient saidthat at that time his speech was not impaired, but he experienced transientweakness in both arms. Since then he noticed that he was unable to write incursive, but he could print upper and lower case letters. Because the patienthad a pacemaker, an MRI could not be done. Functional neuroimaging(SPECT), however, revealed bilateral hypoperfusion of the parietal and occipitallobes. Uptake in the basal ganglia was normal and symmetrical. CarotidDoppler imagery showed no hemodynamically significant carotid arterialstenotic or occlusive disease. The patient was discharged home still unableto write in cursive. At his bank his new signature (Figure 7.1) was accepted andthe patient did not feel that his deficit affected his daily living.Alien hand syndromeThe alien hand syndrome is characterized by the patient not recognizing theactions of one of his hands as self-generated, instead experiencing the hand’sactions as autonomous and elicited by an outside agency. The patient may ignorethe hand or delusionally conclude it belongs to another. Typically the nondominanthand is the alien hand. Case literature describes one hand graspingunneeded objects and refusing to release them, constantly groping bedclothes,objects and body parts, and the compulsive manipulation of tools or objects. The