Letters

however uncommonly, may occur as a sign of focal cerebral disease. This matter was known to Arnold Pick, who provided the first report devoted to micrographia in 1903.4 A patient who had exhibited mic-rographia but lacked Parkinsonism was found at necropsy to have a syphilitic infarct of the left thalamus opticus (at the genu of the internal capsule) and other small infarcts. Pick did not discuss microg-raphia as a distinctive feature of Parkinson-ism, although he mentioned in passing its similarities to the handwriting changes caused by chronic manganese exposure, an intoxication often associated with other Parkinsonian features as well. Although the cases of Pick and the present report do not permit a more precise localisation for the responsible lesions, both illustrate that other forms of subcortical pathology may produce micrographia as distinctive as that found with Parkinsonism. Especially with unilateral presentation, one can be confident of the diagnosis of Parkinson's disease only when other cerebral pathology sharing a similar anatomical focus has been excluded. Even with as characteristic a Parkinsonian finding as micrographia, this case illustrates the need for vigilance in the search for other, less common forms of neurological disease