Abstract
A 62-year-old right handed man suddenly developed difficulty in reading and writing. Brain CT and MRI showed cerebral infarction in the left posterior inferior temporal lobe. Neurological examination revealed alexia with agraphia and, to a lesser extent, anomia and disturbance of verbal comprehension. Both reading and writing difficulties were prominent in Kanji compared with Kana. Copying letters was correctly performed. The patient recovered well from reading difficulty, but writing difficulty, especially in using Kanji, remained almost unchanged. Three-dimensional surface display with 123I-IMP showed cortical hypoperfusion areas in the lower half of the middle temporal gyrus and the inferior temporal gyrus. Cerebral blood flow in the angular gyrus and superior temporal gyrus was preserved.
Alexa with agraphia due to the left posterior inferior temporal lesion has been reported in Japan. However, the anatomical distribution of lesions responsible for alexia with agraphia remains to be elucidated. The present case suggests that cortical areas in the left lower middle temporal and inferior temporal gyri play an important role in Kanji reading and writing, especially in Kanji writing, and concurrence of amnestic aphasia.
