The patient is a 63 year old
right handed woman with history of hypertension and non-insulin dependent
diabetes mellitus, who complained of episodic right arm parasthesia and
inability to read.
On neurologic examination, she
was an alert, oriented middle-aged woman. She had a fluent anomic aphasia(occasional word-finding difficulty and paraphasias, intact repetition).
She
could write a grammatically complex sentence, but was unable then to read it
back. She had difficulty recognizing some letters of the alphabet, but if she
could spell out the individual letters verbally, she had no difficulty in
recognizing the word, i.e., alexia without agraphia.
She had hemi-achromatopsia(loss of color vision) in the right visual field, and a right homonymous
superior quadrantanopsia. There was a very mild right pronator drift but
otherwise normal motor exam, and a slight decrease in pinprick perception in
the right hemibody. She had symmetric reflexes and flexor plantar responses.
Initial work-up included a CT
demonstrating a medial left occipital infarct involving the left side of the
splenium of the corpus callosum. Cardiac workup was normal and MR angiogram
revealed only mild narrowing of the left posterior cerebral artery.
Despite
anticoagulation and increased BP, the patient progressed to a complete right
homonymous hemianopsia, with a mild right hemiparesis, and right hemibody
sensory abnormalities.
She developed a mild anomic aphasia in addition to
continued alexia without agraphia. Subsequent imaging with MR revealed
extension of the infarct into the left posterior cerebral artery territory.
