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C.M. Andreoli, J.F. Rizzo; Cognitive Slowing Isolated for Reading . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1964.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To report two patients who presented with slowness for reading associated with disruption of sub-cortical fibers of the dominant hemisphere, parieto-occiptal region. Methods: Retrospective review of two case histories. Results: Patient 1 was a 51 year old woman with 6 weeks of difficulty reading described as seeing the words clearly, but being too "pre-occupied" to understand them. She "had to think to read", although there was no change in her ability to comprehend, write or understand speech, even in her demanding job as an executive secretary. She had had breast cancer 8 years earlier, treated with mastectomy, and subsequently had a single metastasis to her sternum. Her medicines included tamoxifen for the past two years. The examination revealed acuity of 16/20 and J1 reading acuity OU. She had no difficulty correctly identifying letters or numbers, but showed a brief delay in developing an understanding of the meaning of some longer words. There were no paraphasic errors of speech or writing difficulty. Visual fields showed a right homonymous hemianopsia. MRI of the brain showed a left parieto-occipital lesion (4.5 x 5.5 x 5.5 cm) consistent with metastasis. Patient 2 was a 60 year-old woman who reported slowness of reading. She had had lung adenocarcinomna diagnosed 3 years earlier. Following resection of the tumor, a left parieto-occipital metastasis was found and treated with gamma knife therapy. She developed a receptive aphasia, which resolved completely with surgical resection of the brain tumor 18 months later. Following surgery, she developed her present complaint. Neuro-ophthalmic exam was notable for 16/20 and J1 visual acuity OU. On attempted reading she correctly identified letters and numbers, and had no paraphasic errors of speech or writing difficulty, but she did have difficulty interpreting the meaning of some longer words. Visual fields revealed a right homonymous paracentral scotoma. A more recent MRI showed a tumor and surrounding edema at the parieto-occiptal temporal junction on the left. Conclusions: We report two cases in which a deep, left parieto-occipital lesion (tumor; post-surgery effect) produced isolated difficulty with reading not associated with any obvious aphasic abnormalities. This seems to represent an extremely subtle form of alexia without agraphia, one that would be missed by standard neuro-ophthalmic examination, although probably uncovered by more detailed language testing. In patient one, reading difficulty was the initial symptom that lead to the diagnosis of a brain metastasis.
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