[Kanji-predominant alexia with agraphia in opticospinal multiple sclerosis]

Area of Science:

• Neurology
• Neuroscience
• Clinical Medicine

Background:

• Multiple Sclerosis (MS) is a chronic autoimmune disease affecting the central nervous system.
• Opticospinal MS (OSMS) is a subtype characterized by optic nerve and spinal cord involvement.
• Alexia with agraphia is a rare neurological symptom involving difficulties with reading and writing.

Observation:

• A 55-year-old male with a history of relapsing-remitting OSMS presented with Kanji-predominant alexia with agraphia.
• Neurological examination revealed impaired Kanji reading and writing, with mild naming difficulties but preserved comprehension and repetition.
• Brain imaging (MRI and SPECT) showed lesions in the left temporo-parietal lobe, including the postero-inferior temporal lobe and inferior parietal lobule.

Findings:

• Steroid therapy led to improvement in Kana alexia and agraphia, and Kanji alexia.
• Kanji agraphia showed persistent deficits, suggesting specific lesion localization.
• MRI revealed resolution of the inferior parietal lobule lesion, while the postero-inferior temporal lobe lesion remained unchanged post-treatment.

Implications:

• The findings suggest that lesions in the left inferior parietal lobule and postero-inferior temporal lobe contribute to Kanji-predominant alexia with agraphia in OSMS.
• Persistent Kanji agraphia may be linked to the residual lesion in the left postero-inferior temporal lobe.
• This case underscores the importance of detailed language assessment and neuroimaging in diagnosing and understanding rare neurological presentations in MS.