Journal of Neurology, Neurosurgery, and Psychiatry 1986;49:458-465 Letters paraphasias. Oral comprehension was impaired: he scored 15/36 on the Token Ideomotor apraxia arising from a purely deep Test. Spontaneous writing and writing to lesion dictation were impossible: he produced isolated signs among which only few letters Sir: Ideomotor apraxia arising from a purely were recognisable. Repetition was good deep lesion has not been reported frequently except for being dysarthric. He scored 5/36 in the literature. Even in the few cases pub- on the Raven's Coloured Progressive Matrilished,' 2 the lesions were not strictly ces. He had no oral apraxia. Testing for conconfined to the basal ganglia. Systematic structional apraxia was impossible: in every studies,34 however, have revealed the pres- instance the patient tried to write instead of ence of ideomotor apraxia in about 15% of copying the model. He scored 35/72 (cut-off patients with lesions confined to thalamic or score: 53/72)5 on De Renzi6 ideomotor lenticular regions. We report the case of a apraxia test. There was no difference patient with a haemorrhage confined to the between arm/hand movements (18/36) and head of the left caudate nucleus and the con- finger movements (17/36). There was, howtiguous arm of the internal capsule, who had ever, a striking difference between single severe ideomotor apraxia and aphasia as movements (25/36) and sequences (10/36). well. Even though the haemorrhagic nature Our patient also had a mild apraxia of of the lesion renders the interpretation of the use: for instance, when asked to light a cananatomoclinical correlations rather difficult, dle he could not manage to light the match. this case is interesting because of the Aphasia following a deep lesion has long coexistence of severe ideomotor apraxia and been accepted7 and it will not be commented a deep lesion. on. Ideomotor apraxia arising from a purely A 61-year-old right-handed male with 4 deep lesion has been occasionally reported in group studies. Our patient had a small years of education suddenly developed aphasia and a right hemiparesis. Three sub- and well localised lesion which caused, sequent CT scans performed on the 1st, 8th among other deficits, a severe ideomotor and 19th day after onset, showed a small apraxia. It would seem that the role of deep area of increased density consistent with an structures in the genesis of apraxia, not intraparenchymal haemorrhage limited to taken into account by the majority of the head of the left caudate nucleus, the authors with few exceptions,8 9 deserves anterior limb of the internal capsule and the reconsideration. ANNA BASSO, medial part of the lenticular nucleus (fig). SERGIO DELLA SALA, Neuropsychological assessments were perNeuropsychology Center, formed 20 days after onset. His speech was University of Milan, dysarthric. In oral confrontation naming Via F Sforza, 35, there were frequent word-finding difficulties 20122 Milan, Italy with rare circumlocutions and semantic References Von Monakov C. Die Lokalisation im Grosshirn und der Abbau der Function durch kortikale Herde. Wiesbaden: Bergmann, 1914:489-574. 2 Kleist K. Die psychomotorischen Stoerungen und ihr zu den Verhaeltpuis Motilitaetsstoeungen bei Erkrankungen der Stammganglien. Monatsschrift fuer Psychiatrie und Neurologie 1922;521:253-302. 'Basso A, Luzzatti C, Spinnler H. Is ideomotor apraxia the outcome of damage to welldefined regions of the left hemisphere? Neuropsychological study of CT correlation. J Neurol Neurosurg Psychiatry 1980;43:118-26. 4Basso A, Faglioni P, Luzzatti C. Methods in neuro-anatomical research and an experimental study of limb apraxia. In: Roy EA, ed. Neuropsychological Studies of Apraxia anid related disorders. Amsterdam: NorthHolland, 1985. 'De Renzi E, Faglioni P, Sorgato P. Modalityspecific and supramodal mechanisms of apraxia. Brain 1982;105:301-12. 6 De Renzi E, Motti F, Nichelli P. Imitating gestures: a quantitative approach to ideomotor apraxia. Arch Neurol 1980;37:6-10. 7 Marie P. Revision de la question de l'aphasie: que faut-il penser des aphasies sous-corticales? Sem Med 1906;42:493-500. 'Hore J, Meyer-Lohmann J, Brooks VB. Basal ganglia coding disables learned arm movements of monkeys in the absence of visual guidance. Science 1977;195:584-6. 9Kimura D. Neuromotor mechanisms in the evolution of human communication. In: Steklis HD, Raleigh MJ, eds. Neurobiology of Social Communication in Primates. an Evolutionary Perspective. New York: Academic Press, 1979:197-219. ' Unusual EEG pattern in rubella encephalitis Fig Post-contrast CT scan 8 days from onset. The luxury perfusion well defines the infarcted area. 458 Sir: Encephalitis is a rare but well recognised complication of rubella infection.' The EEG findings in the acute phase2 are reported to show continuous slow activity with no specific features. We report a case of rubella encephalitis with unusual repetitive complexes. A 15-year-old Japanese boy with no past history or family history of note, presented with a 4 day history of fever and rash. The rash started on the face, spread down to the body, and faded 2 days later. The day prior to admission, he developed headache and dizziness and within 24 hours had become drowsy and lapsed into coma. Examination revealed an unconscious, -restless patient only responding semi-purposefully to painful stimuli. There was moderate neck stiffness but no focal neurological deficit. The pupils were 4 mm in diameter, and reacted to light. The fundi were normal. Deep