ABSTRACT NUMBER: ESOC2026A216 ALEXIA WITHOUT AGRAPHIA: A RARE AND OFTEN MISSED ENTITY

Abstract Background and aims Alexia without agraphia is a disconnection syndrome characterized by inability to read with preserved ability to write. It is caused by the combined effect of two lesions: splenium of the corpus callosum and occipital lobe of the dominant hemisphere. Methods We report a case of an 88-year-old highly functioning patient with history of hypertension and atrial fibrillation who presented as a transfer from an outside hospital for evaluation of confusion. He was initially treated for metabolic encephalopathy secondary to urinary tract infection. Of note, his warfarin was discontinued 10 days prior because of hematoma of the right hip after sustaining a motor vehicular accident. Results His admission INR was 1.4. Clinical examination was notable for a patient who appeared frustrated. He had memory impairment of recent events, was unable to tell the correct month and had difficulty naming objects. He was, however, able to write sentences but cannot read his own handwriting as well as printed materials presented to him. Cranial nerve examination was significant for right homonymous hemianopia. The rest of his motor exam was non focal. Subsequent MRI of the brain revealed restricted diffusion lesions in the left posterior cerebral artery territory involving the hippocampus, callosal splenium, occipital lobe and left thalamus. His stroke was presumptively cardioembolic in nature. Conclusions In summary this case highlights the rare syndrome of alexia without agraphia. It stresses the importance of performing a thorough language evaluation in patients presenting with homonymous hemianopia, as otherwise, clinicians may overlook impairments in writing or reading. Conflict of interest Marilou Ching: nothing to disclose