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Brain MRI Lesions in Alexia Without Agraphia: A Case-Control Study.

Jeremy N Shapiro1, Aseem Sharma, Jonathan D Trobe

  • 1Kellogg Eye Center and Department of Ophthalmology and Visual Sciences (JNS, JDT, SK), University of Michigan, Ann Arbor, Michigan; Departments of Radiology (AS) and Neurology (JDT, SK), University of Michigan, Ann Arbor, Michigan; and Department of Ophthalmology (RDW), Medical College of Wisconsin, Milwaukee, Wisconsin.

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Summary

Alexia without agraphia (AWA) involves reading disturbances linked to left posterior cerebral artery (PCA) damage. This study used MRI to find brain lesion patterns supporting existing AWA theories.

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Area of Science:

  • Neuroscience
  • Neurology
  • Radiology

Background:

  • Alexia without agraphia (AWA) is an acquired reading disorder linked to left posterior cerebral artery (PCA) infarction.
  • Two main hypotheses for AWA pathogenesis exist: visual cortex-language cortex disconnection and visual word-form agnosia.
  • This study aimed to use advanced brain imaging to investigate these hypotheses.

Purpose of the Study:

  • To determine if refined brain imaging could provide further support for existing hypotheses on the pathogenesis of Alexia without agraphia (AWA).
  • To investigate the role of specific brain regions in the development of AWA following left PCA infarction.

Main Methods:

  • A case-control study involving 9 patients with AWA and 18 patients without AWA, all with left PCA infarctions.
  • A neuroradiologist masked to AWA status reviewed diffusion-weighted and fluid-attenuated inversion recovery brain MRIs.
  • Lesions were characterized in the splenium, left forceps major, and left fusiform gyrus.

Main Results:

  • Patients with AWA exhibited various combinations of lesions in the splenium, left forceps major, and left fusiform gyrus.
  • In patients with AWA, one region was involved in 3, two regions in 3, and all three regions in 3 patients.
  • The majority of patients without AWA (89%) showed no involvement in these three regions.

Conclusions:

  • The study provides imaging evidence supporting the two prevailing hypotheses for AWA.
  • MRI findings of lesions in the splenium, left forceps major, or left fusiform gyrus warrant further neuropsychological evaluation for AWA.