Hypergraphia: Illustrating clinical pictures

Abstract

Introduction

Hypergraphia is an extensive writing tendency sometimes coupled with hyperreliogiosity and atypical sexuality, completing a syndrome described by Waxman and Geschwind in 1975 during interictal phases of patients with temporal lobe epilepsy. Nevertheless, it may arise from any temporolimbic lesion, usually in the right hemisphere, in contrast to the schizophreniform psychosis more often seen in left-sided lesions.

Objective

A review on the lateralizing significance of temporolimbic lesions, highlighting the (un)specificity of hypergraphia, after a case report concerning a patient with both hypergraphia and schizophreniform psychosis.

Methods

Analyse patient's clinical records and PubMed review, using hypergraphia, epilepsy and psychosis as keywords.

Results

We report a 74-year-old male admitted due to aggressiveness. The patient had a traumatic brain injury in his 20s with secondary left temporal epilepsy. He lived in a psychiatric asylum, for almost 40 years, with the diagnosis of schizophrenia, showing fluctuant atypical sexual behavior. After being transinstitutionalized to community nursing-home he developed meningoencephalitis, leading to medication change and behavior relapse. He showed viscosity, circumstantiality, soliloquy, euthymic mood and normal cognition. He wrote profusely, e.g. lists of various categories and letters to eminent clerics and politics. His diary was scanned for illustrative purpose.

Conclusions

Hypergraphia is an uncommon but easy to find symptom that deserves the full attention of the clinician, especially in the differential diagnosis between schizophreniform psychosis and temporal epilepsy.

Disclosure of interest

The authors have not supplied their declaration of competing interest.