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Patients with cerebral lesions out of motor and sensory strips are often overlooked, especially those with frontal lobe symptoms, which are subtle and elusive. We report on a patient with a left anterior cerebral artery infarct, who had an unusual manifestation—namely, repetitive sentence writing.
A 58 year old right handed woman had a transient lapse of consciousness when riding a bicycle on 3 June 1995. She had no vomiting, convulsion, or sphincter problems, and walked home after having taken a rest. Brain CT performed at a local hospital was normal. Next day, she visited our hospital because of right leg weakness, urinary urgency, persistent mutism, and slow mentality. On admission, the patient seemed alert and had normal vital signs, but was mute and responded slowly to oral commands. Neurological examination disclosed a grasp reflex on both hands, being stronger on the right, gegenhalten rigidity, right leg weakness, and clonic motor perseveration of the right hand. With the right hand, she would hit the bed, her own body, cutlery, and nearby objects before her. She knocked herself on the head if we asked her: “Do you have …