Neurorehabilitation of alexia without agraphia: A case report

Abstract

Introduction. Alexia without agraphia is an impairment of reading ability. Speech, auditory comprehension, repetition and writing are relatively intact. Due to a damage of the splenium of corpus callosum, alexia without agraphia is considered to be an interhemispheric disconnection syndrome. Case Report. We presented a 71-year-old male, with chronic hypertension, diabetes mellitus and dyslipidemia. The magnetic resonance imaging showed a lesion in the left medial temporal region, including the equilateral thalamus, posterior cingulate gyrus, splenium of corpus callosum, lingual occipital gyrus, and the tail of the hippocampus. Lacunar ischemia was found on the right side of cerebellum. The neuro-linguistic diagnostic protocol included the Mini Mental State Examination, Boston Diagnostic Aphasia Examination, Boston Naming Test and phonemic and category fluency tests. We have also designed a clinical protocol for color recognition assessment. The results showed a mild cognitive impairment related to the time and space orientation, delayed memory and reading. On the speech and language levels, a severe acquired alexia without agraphia was registered which was not associated with other language modalities. Conclusion. The neuro-linguistic tests and clinical techniques provide a rather reliable diagnostic criteria, which is the basis for neuro-rehabilitation. The rehabilitation protocol refers to training techniques: tactile-kinesthetic recognition of graphemes and application of various reading techniques, such as letter-by-letter reading, Multiple Oral Re-reading, melodic intonation therapy and oral reading technique in order to facilitate rehabilitation of reading.