Alexia without agraphia in a young adult with ischemic stroke: A case report

Abstract

Introduction: Ischemic stroke in young adults is less common than in older adults, but its occurrence warrants further investigation to determine the cause and appropriate treatment to improve outcome. One of the stroke manifestations is a disconnection syndrome, such as alexia without agraphia, a condition in which a patient cannot read but the ability to write remain relatively intact. Pure alexia is associated with the lesion in the medial occipitotemporal lobe in the dominant hemisphere, also known as the visual word form area (VWFA). Case Report: Here we report a case of a 30-year-old male, who presented with an acute complaint of inability to read without any difficulty in writing, accompanied by right homonymous hemianopia which occurred two days before admission. Initial brain scan was normal. However, the repeated brain scan two weeks after admission showed infarction in the left occipitotemporal lobe. He had no known previous vascular risk factors other than obesity. The evaluation during admission showed high blood pressure, dyslipidemia, and suggestive of autoimmune disease, all of which might contribute to the ischemic stroke occurrence. During follow-up he was referred for the neuropsychological assessment and rehabilitation as well as to the outpatient clinic for use of antithrombotic as secondary prevention. He showed gradual improvement in his symptoms after sixth months follow-up. Conclusion: Stroke in young adults is an increasing problem nowadays due to its rising incidence and more diverse pathogenetic mechanisms and related high morbidity. One of the neurological deficits found in stroke is a disconnection syndrome such as alexia without agraphia in which there is an acquired inability to read with relatively preserved writing ability. Pure alexia found in this case was due to an infarction of the occipitotemporal lobe that disconnects primary language areas from incoming visual information.