Correct! She is demonstrating the manifestations of “alexia without agraphia,” also known as “pure alexia.” It is a recognition disturbance for written language (and often other familiar symbols). It is not an aphasia (language disturbance). Written information cannot reach the posterior portion of the angular gyrus in the left temporal lobe. This disconnection happens most often when a lesion—almost always an ischemic stroke in the domain of the posterior cerebral artery—damages the left medial occipital lobe, causing a right homonymous hemianopia, and extends anteriorly enough to damage the splenium of the corpus callosum to interrupt transmission of visual information from the intact right visual cortex to the left angular gyrus. Patients can spell, understand spoken language, and express themselves normally, because those functions are generated in the angular gyrus without needing transmission from the visual cortex. Which critical neuro-ophthalmic abnormality was bound to be present (although not always!) and not mentioned in the vignette? A complete right homonymous hemianopia. This patient did have a left posterior cerebral artery stroke with forward extension into the splenial region.

Over time, her reading deficit gradually improved, but she still hesitated. The homonymous hemianopia was permanent.

Incorrect

Incorrect