Elsevier

Brain and Language

Volume 3, Issue 2, April 1976, Pages 229-245
Brain and Language

Subangular alexia without agraphia or hemianopsia

https://doi.org/10.1016/0093-934X(76)90019-5Get rights and content

Abstract

A 40 year old right-handed woman underwent resection of an unruptured vascular malformation which was located just deep to the left posterior insula. Postoperatively she demonstrated a transient syndrome of alexia without agraphia or hemianopsia. Analysis of her postoperative findings, in conjunction all available anatomical data, let to the conclusion that the responsible lesion was in the white matter of the left occipitotemporal region, below the angular gyrus and lateral to the lateral ventricle. Hence the lesion in the present case was truly subangular, and is therefore distinctly differentiated from the classical lesion in alexia without agraphia, which may be described as splenio-occipital.

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    Connectivity between the FFA and SPL may be mediated by the vertical occipital fasciculus (VOF), which has projections to the posterior intraparietal sulcus of the dorsal attention network and the fusiform gyrus of the visual association network (Budisavljevic et al., 2018; Takemura et al., 2016; Yeatman et al., 2014). Supporting the functional evidence of dorsal attention and visual association network communication, the VOF has been implicated in reading (Greenblatt, 1973, 1976), depth perception (Oishi et al., 2018), and object related motor actions (Budisavljevic et al., 2018). Although the VOF connects regions of the visual association and dorsal attention networks, the white matter architecture that would support direct connectivity between the nodes of interest in this study (the SPL and FFA) is not understood.

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    Finally, a secondary atrophy of the splenium of the corpus callosum could be observed. Thus the lesion met the criteria given by Greenblatt (1976), in order to be qualified as subangular, i.e. subcortical and ventral to the angular gyrus. Nevertheless, its localization was slightly posterior and dorsal to those of the original description (Mayer et al., 1999, p. 1110).

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    If we expand the focus to paralinguistic functions such as literacy, a recently re-discovered fiber pathway (Yeatman et al., 2014), the vertical occipital fasciculus (VOF), becomes yet another potentially important pathway2. This pathway appears to connect the lateral occipitotemporal sulcus and gyrus (associated with the processing of visual word forms) with inferior, and possibly superior, parietal regions that are important for literacy and numeracy (Bouhali et al., 2014; Greenblatt, 1973, 1976; Yeatman, Rauschecker, & Wandell, 2013). To date, much of the research on perisylvian long association fiber pathways has focused on speech perception and language comprehension, and has largely neglected the contribution of cortical and subcortical networks for speech production.

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Presented in part to the International Neuropsychology Society, Tampa, Florida, February 5, 1975.

1

Present address: Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York 10461, U.S.A.

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