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Yoshihiro Takayama, MD; Morihiro Sugishita, DrHS, DrMS; Ichiro Akiguchi, MD; Jun Kimura, MD

Arch Neurol. 1994;51(3):286-291.

Abstract
Objective
To clarify the characteristics and the localization of isolated calculation disturbances due to left parietal lesions.

Design
Case series.

Setting
Tertiary care hospital.

Patients and Other Participants
Three referred patients with isolated calculation disturbances due to stroke in the left parietal region. Sixteen volunteers matched for age and education constituted the control group.

Outcome Measures
Neuropsychological tests, including a battery of tests for acalculia and the Wechsler Adult Intelligence Scale, and magnetic resonance imaging were performed.

Results
Three patients made calculation errors in the process where a number of steps were carried out simultaneously. The patients showed no aphasic components in number operations. They understood the basic processes of calculation. They showed little difficulty in the retrieval of table values. The patients had no impairment in aligning arithmetic problems or in assigning and maintaining place-holding values. They did not show any deficit of immediate memory for calculation problems. Overlapping lesions were located along the left intraparietal sulcus.

Conclusion
The area lying along the left intraparietal sulcus is critical for isolated parietal acalculia. The profile of isolated acalculia suggests that it results from the disruption of the working memory for calculation.

Author Affiliations
From the Department of Rehabilitation, Tokyo (Japan) Metropolitan Institute for Neuroscience (Drs Takayama and Sugishita), and the Department of Neurology, Faculty of Medicine, Kyoto (Japan) University (Drs Akiguchi and Kimura). Dr Sugishita is now with the Department of Cognitive Neuroscience, Research Institute of Logopedics and Phoniatrics, University of Tokyo.

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