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Posterior or pure alexia is an uncommon acquired reading disturbance in which the loss of the ability to read is not associated with other language deficits.1 It has been reported almost without exception after left (dominant) hemispheric lesions involving visual temporo-occipital pathways and splenium of the corpus callosum, and is considered to be a strong lateralising feature. The explanations of this deficit are on the basis of: (a) a disconnection syndrome—that is, the lesion prevents visual information from reaching the language area, or (b) the presence of a lateralised visual language association area residing in the dominant posterior inferior temporal lobe. We describe a patient with an atypical interhemispheric organisation who developed pure alexia and features of apperceptive agnosia after a right occipitotemporal infarction.
The patient is a 71 year old man, with a college degree education. He writes, uses a fork, spoon, or knife with the right hand, but prefers to use his left hand or leg for every other activity. He has no antecedents of sinistrality in first degree relatives. At the age of 68 he had a myocardial infarction complicated with an interventricular communication and heart failure. He underwent cardiac surgery and recovered. Immediately after surgery his examination showed a left visual hemianopia and he complained of inability to read. …