Selective reading slowness in a traumatic patient with impairment in basic visual processes

Following a closed-head injury, G.M., a 17-year-old male, showed a reading disturbance in the absence of other cognitive deficits. G.M.'s reading was exceedingly slow, although virtually error free. Analysis of his disorder indicated an inability to read words presented tachistoscopically to the left (spared) visual field. Therefore the reading deficit cannot be interpreted as simply due to the visual field reduction (hemianopic alexia). Reading speed was clearly affected by word length, a finding typical of letter-by-letter reading. Both behavioral and psychophysical testing indicated a selective reduction of visual discrimination and detection (particularly in the range of high spatial frequency information) in portions of the left hemifield which appeared spared upon perimetric examination. Overall, it is suggested that the reading deficit, phenomenologically similar to that of other letter-by-letter readers, can be interpreted as due to a combination of basic visual perturbations: visual field cut with macular splitting and deficit of processing of high spatial frequency information.