Abstract
Mirror writing (MW) refers to the production of individual letters or whole word strings in reversed direction. When held to a mirror, these letters or words can be read normally. We observed MW in a considerable number of stroke patients. Of the 86 patients screened 15 (17.5%) showed at least one instance of mirror writing in any of the tasks. Both right (14% of 36 patients) and left (20% of 50 patients) hemisphere damaged patients produced reversed letters only when writing with their left hand, respectively the contralesional and ipsilesional hand. The dissociated performance between the two hands in brain damaged patients is relevant to the interpretation of MW because, unlike all other peripheral dysgraphias, MW affects the non-dominant hand only. Importantly, healthy elderly also showed MW solely when writing with their left hand (6.9% of 86 participants). MW in controls was less frequent but qualitatively similar to that observed in brain damaged patients. This finding is consistent with the motor interpretation of MW that assumes an inability to transform the stored letter forming programmes for left hand writing. However, several cases have been reported in the literature of a more pervasive form of MW whereby patients mirror reverse entire words or sentences. This pattern has been observed in children learning to write but it has never been observed in healthy adult volunteers. We propose that the diagnosis of MW should be limited to the reversal of whole words, multi-digit numbers and full sentences, which reveal a disorder in coding the correct direction of writing rather than an inability to accomplish the correct spatial orientation of single letters.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Buxbaum LJ, Coslett HB, Schall RR, McNally B, Goldberg G (1993) Hemispatial factors in mirror writing. Neuropsychologia 12:1417–1421
Chan JL, Ross E (1988) Left-handed mirror writing following right anterior cerebral artery infarction: evidence for non-mirror transformation of motor programs by right supplementary motor area. Neurology 38:59–63
Cornell JM (1985) Spontaneous Mirrorwriting in children. Can J Psychol 39:174–179
Critchley M (1928) Mirror-writing. Kegan Paul, Trench, Trubner & Co. Ltd, London
Della Sala S, Cubelli R (2006) “Directional apraxia”: A unitary account of mirror writing following brain injury or as found in normal young children. J Neuropsychol, in press
Ellis AW (1988) Normal writing processes and peripheral acquired dysgraphias. Lang Cogn Processes 3:99–127
Erlenmeyer A (1879) Die Schrift Grundzuge ihrer Physiologie und ihrer Pathologie. Stuttgart
Gottfried JA, Sancar F, Chatterjee A (2003) Acquired mirror writing and reading: evidence for reflected graphemic representations. Neuropsychologia 41:96–107
Kachi T (1984) Mirror writing in the aged. Neurol Med 20:80–82
Kuzuya M, Yamamoto T, Kuzuya F (1991) Mirror writing in the aged. Japan J Geriatr 28:499–503
Laveran IM (1900) Presentations d’ouvrages manuscripts et imprimes. Bulletin de l'Académie de Médecine 43:86–87
Lebrun Y, Devreux F, Leleux C (1989) Mirror-writing. In: Aaron PG, Joshi RM (eds) Reading and writing disorders in different orthographic system. Kluwer Academic Publishers, Dordrecht, pp 355–378
Liepmann H (1906) Der weitere Krankeitsverlauf bei dem enseitig Apraktischen und der Gehirnbefund auf Grund von Serienschnitten. Mschr Psychiat Neurol 20:217–243
Oblu N, Sandulescu GH, Iovu C (1967) Scrisul in oglihda in unele sihdroame neurochirurgicale. Studii si cercetari de neurology 12:187–195
Paradowski W, Ginzburg M (1971) Mirror writing and hemiplegia. Percept Mot Skills 32:617–618
Russell JW (1900) A case of Mirror writing. Birmingham Medical Review 68:95–100
Sato K (1979) A clinical study on aphasic agraphia of cerebral vascular disease origin, in reference to mirror writing and perseveratory paragraphia. Tohoku-igaku-zasshi 92:26–42
Shallice T, Warrington EK (1980) Single and multiple component central dyslexic syndromes. In: Coltheart M, Patterson KE, Marshall JC (eds) Deep dyslexia. Routledge and Kegan Paul, London, pp 119–145
Schott G (1980) Mirror movements of the left arm following peripheral damage to the preferred right arm. J Neurol Neurosurg Psychiatry 43:768–773
Schott G (1999) Mirror writing: Allen's self observations, Lewis Carroll's “looking glass” letters, and Leonardo da Vinci's maps. Lancet 354:2158–2161
Streifler M, Hofman S (1976) Sinistrad mirror writing and reading after brain concussion in a bi-systemic (orientooccidental) polyglot. Cortex 12:356–364
Tashiro K, Matsumoto A, Hamada T, Moriwaka F (1987) The aetiology of mirror writing: a new hypothesis. J Neurol Neurosurg Psychiatry 50:1572–1578
Wang X-de (1992) Mirror writing of Chinese characters in children and neurological patients. Chinese Med J 105:306–311
Wang X-de, Xiaojie C, Haibo C (1998) Mirror writing in the elderly. Chinese Med J 111:641–643
Wernicke C (1906) Der Aphasische Symptomencomplex. In: von Leyden E, Klemper F (eds) Die deutsche Klinik am Eingange des 20: Jarhrunderts. Urban and Schwarzenberg, vol. 6, Berlin/ Vienna, pp 487–556
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Balfour, S., Borthwick, S., Cubelli, R. et al. Mirror writing and reversing single letters in stroke patients and normal elderly. J Neurol 254, 436–441 (2007). https://doi.org/10.1007/s00415-006-0384-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00415-006-0384-8