It happened to a reading instructor, of all people. M.P. (name withheld) was standing at the head of her kindergarten class when she went to fetch the attendance sheet off her desk. But suddenly she was struck with a realization — she couldn’t read the names. They appeared to her as hieroglyphs, each a set of incomphrensible symbols. Panic set in as she realized she could no longer read her lesson plans either.

After an arduous, fright-filled trip to the hospital, M.P. learned her diagnosed stroke had actually produced a rare reading disorder called “alexia without agraphia.” Her ability to understand words and write them remained intact, but she could not read them, even immediately after writing them herself. But in a testament to humans’ will to triumph over adversity, M.P. devised a method to tackle her word blindness that caught the attention of neurological researchers, who published her story in the journal Neurology.

M.P.’s rehabilitation journey pursued many paths. She began by dabbling in the very reading exercises she often relayed to her students — sight words, phonics — but ultimately to no avail. She made use of captioned flash cards, writing techniques, and other methods, but these too only succeeded in improving her daily tasks, not her reading ability. So, M.P. decided to try her own hand at rehabilitation. She realized that if she could trace the letters herself, one by one, and physically run a finger over each letter, its meaning would become apparent.

Careful guiding and tracing over an “M,” and then a looping finger over an “O,” and finally, a “T,” produced an M.P. confident enough to take a stab at the word: mother. She was right. “She sort of picked up this tactile approach — truthfully — herself,” her mother, S.P., told the researchers. “She’s the one who reinvented the wheel!”

M.P.’s disorder is a curious one, from both neurological and epidemiological perspectives. Alexia typically refers to the loss of reading ability. While it may co-occur with expressive or receptive aphasia, the inability to produce or receive spoken word, M.P.’s case is distinct in that it comes “without agraphia,” meaning her ability to put pen to paper is unaffected. She can write her name and instantly fail to understand it, even if she has the memory of what she’s written. This reveals a communication breakdown between certain parts of her brain, the researchers point out.

Interestingly, the first hypothesis devised in 1892 still holds largely true today. There seems to be a deficit in the way pure M.P.’s left angular gyrus, her “language zone,” interacts with her visual cortex. Conventional wisdom implicates subcortical lesions as the culprits, and three distinct lesions in particular. The team argues there is either a lone lesion stretching across M.P.’s corpus callosum (the tissue that connects the left and right hemispheres), lesions on both the corpus callosum and the left visual cortex, or a lesion on both the corpus callosum and the lateral geniculate nucleus, which relays visual information received by the retina.

Whichever scenario is at work, M.P.’s intuitions about words have startling capabilities. Not too long ago, M.P. was in the middle of a therapy session when she was handed two pieces of mail. Instinctively, she handed one to her mother and kept one for herself, saying “This is your friend and this is my friend.” Though she couldn’t read either address to know for whom it was intended, M.P.’s emotional response to the symbols triggered a keen absorption of their meanings.

The research team caught up with M.P. 10 months after her stroke. They asked her how she was faring with her alexia without agraphia. Though her reading ability is improving, she said, she remains unable to return to school, as she now works at a fitness center, selling memberships at the front desk. But despite her loss of literacy, the greatest sadness doesn’t come from her inability to read personally, but to regale children with the gift of storytelling.

“One day my mom was with the kids in the family,” she told the researchers, welling with tears, “and they were all curled up next to each other, and they were reading. And I started to cry, because that was something I couldn’t do. I could be there, but I couldn’t pick up the book and read it. That’s something that I’d always done, and it’s something I had a lot of pleasure from. And I couldn’t do it.”

 

Source: Cuomo J, Flaster M, Biller J. Right Brain: A reading specialist with alexia without agraphia. Neurology. 2013.