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Micrographia is a heterogeneous condition in which various parts of the CNS may be involved. An anatomical substrate for micrographia, however, remains to be established. Here, we report on a patient with systemic lupus erythematosus (SLE), who presented with atypical micrographia, which was associated with bilateral lesions in the corticostriatal white matter.
A 30-year-old right-handed woman was diagnosed as having SLE in 2002. She had concomitant leukocytopenia, arthritis, nephritis and high titres of antinuclear antibodies, which satisfied the American Rheumatism Association criteria for SLE. Thereafter, maintenance treatment using corticosteroids was started. She was admitted to the Niigata University Medical and Dental Hospital, Niigata, Japan, in February 2005, because of a high fever and headache with affective incontinence.
Examination showed her muscle strength and the sensory function of her extremities to be normal. She did not have involuntary movements or akinetic–rigid symptoms, as her gait was normal and no rigidity was observed in the neck, body and extremities. No impairment was seen in the rapid alternative movements of her hands. She was well oriented and cooperative. Aphasia was absent; her speech was well articulated and grammatically correct, and she had no difficulty in naming objects. She had no abnormalities in praxis, showing an excellent capacity in imitating and pantomiming, and in using tools with either hand. She could perform a fist–palm-alternating task swiftly. Orofacial apraxia, visuospatial disturbance, unilateral spatial …