Alexia without agraphia in multiple sclerosis: case report with magnetic resonance imaging localization

Area of Science:

• Neurology
• Neuroscience
• Ophthalmology

Background:

• Multiple sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system.
• Alexia without agraphia, the inability to read without the loss of ability to write, is an uncommon neurological symptom.
• Early diagnosis of MS is crucial for effective management and slowing disease progression.

Observation:

• A patient presented with right homonymous hemianopsia and alexia without agraphia as the initial symptoms of relapsing-remitting MS.
• Neuroimaging revealed a lesion in the left occipital subcortical white matter and another in the splenium of the corpus callosum.
• These findings suggested a disconnection between the right occipital visual cortex and language processing areas in the left hemisphere.

Findings:

• The clinical presentation and MRI findings strongly indicated a demyelinating event disrupting visual and language pathways.
• The patient's initial symptoms were directly attributable to the specific lesion locations.
• The subsequent development of periventricular white matter lesions confirmed the diagnosis of MS.

Implications:

• This case underscores the importance of considering MS in patients presenting with unusual neurological syndromes like alexia without agraphia.
• Understanding lesion-brain pathway correlations in MS is vital for accurate diagnosis and localization of damage.
• Recognizing rare initial manifestations can lead to earlier MS diagnosis and intervention, potentially improving patient outcomes.