MEDICAL
IMAGES
RUNNING
HEAD

Pure Alexia: Past and Present
ALICE P. ARMBRUSTER, MA/CCC-SLP* AND EELCO F. M. WIJDICKS, MD†
*Speech Pathology, Mayo Clinic College of Medicine, Scottsdale, Ariz, and
†Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minn

A

54-year-old man suddenly developed an inability to read after renal
transplantation. Neurologic examination
revealed a right-sided hemianopia, and
magnetic resonance imaging showed a
left-sided infarct in the occipital lobe and
temporal lobe. The cause of the embolus
remained unknown.
On examination, the patient had nearnormal primer-level ability to write dictated words. His reading of letters, words,
and numbers was poor and extremely slow
when accurate. He was easily able to
interpret orally spelled words. A convincing difference between object and
letter naming, as expected in pure alexia,
was absent, and there was an inability to
copy, suggesting visual difficulty, not just
a visual-language disconnection. Color
dysnomia was noted, but the patient stated
that he had always been color-blind.
Writing example from Déjérine’s original patient (Monsieur C): “I went on Friday to the
Our case documents one of the dis- Salpetriere to M Charcot who has examined me for a longtime and showed me to his
connection syndromes, alexia without students telling them that I was afflicted with word blindness.” Diffusion-weighted image
agraphia, as best described by Déjérine shows right occipital infarct. Note sudden cutoff in the right posterior cerebral artery on
magnetic resonance angiography.
in 1892.1 Alexia without agraphia (pure
alexia) is associated with lesions of the left
medial occipital lobe and splenium. It occurs because visual input from both occipital areas to the left angular gyrus, where
written information is decoded, is lost. Writing and oral spelling are preserved because perisylvian language areas are intact.
In some cases, including ours, the “purity” of the alexia can be questioned.2
We greatly appreciate the contributions of Joseph R. Duffy, PhD, Department of Speech Pathology, Mayo Clinic College of Medicine,
Rochester, Minn.
1. Déjérine J. Contribution a l’étude anatomo-pathologique et clinique des differentes variétés de cécité-verbale. Mem Soc Biol. 1892;4:61-90.
2. Nadeau SE, Gonzalez Rothi LJ, Crosson B, eds. Aphasia and Language: Theory to Practice. New York, NY: Guilford Press; 2000.
© 2006 Mayo Foundation for Medical Education and Research

Mayo Clin Proc.

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March 2006;81(3):397 •

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