We have presented a patient with a relatively rare syndrome of alexia without agraphia, which occurs as a consequence of vascular lesion in the left medial occipitotemporal gyrus and splenium of corpus callosum (Figures 1, 2 and 3) with abnormalities in the visual field (right sided homonymous hemianopsia
), visual agnosia and anomia for colors, objects and numbers [2, 7], with all modalities of writing preserved.
(3,4) The subsequent neurologic deficits can manifest as partial or complete hemiparesis, homonymous hemianopsia
, Horner's syndrome, facial nerve paralysis, gait issues, or death.
Examination was unremarkable, except for a left homonymous hemianopsia
. At the time, hormonal analysis was as follow; prolactin (PRL) levels 16,980 ng/ml (nl <25 ng/ml), fasting growth hormone (GH) 1.3 ng/ml (nl <5 ng/ml), luteinizing hormone (LH) 1.72 mIU/ml (n16-23 mIU/ml), follicle stimulating hormone (FSH) 2.19 mIU/ml (n14-25 mIU/ml), free T4 6.2 mcg/ dl (nl 5-12 mcg/dl) and morning cortisol 0.63 mcg/dl (nl 5-30 mcg/dl).
(1,2,4) Examples of previously reported presentations include cranial nerve palsies, (5,6) dysphagia, (7) homonymous hemianopsia
, (8) seizures, (9,10) and obstructive hydrocephalus, (2,11-13) as in the current case.
Evaluation of the visual fields showed left homonymous hemianopsia
. All other neurologic assessments were unremarkable.
Contralateral homonymous hemianopsia
is the usual symptom associated with superficial occlusion of a PCA.
Neurologic examination at the time of psychiatric consultation is notable for waxing and waning expressive aphasia, right homonymous hemianopsia
, and mildly decreased strength in the left biceps and forearm.
Robert opened his eyes spontaneously, had a right homonymous hemianopsia
and bilateral facial weakness.
On neurologic examination, the patient had a right homonymous hemianopsia
, optic nerve atrophy, and major visual impairment (left eye--20/100; right eye--20/200).
In most cases, there is bilateral improvement following a unilateral lesion, although contralateral improvement is greater.[25,11,18] Homonymous hemianopsia
is the most emphasized complication, because of the close proximity of the pallidal lesions to the optic tract, but its incidence has been reduced by improved stereotactic techniques. Optimum candidates for VP are those with akinesia partially responsive to medication, bradykinesia with freezing during repetition, asymmetrical severe rigidity, or frequent disabling dyskinesia.[11,18]