Disclosures: Nahyun Kim, MD: No financial relationships or conflicts of interest

Case Diagnosis: 49-year-old male with diabetes mellitus, hypertension, obesity admitted to an acute inpatient rehabilitation hospital for left posterior cerebral artery (PCA) territory infarct status post tissue plasminogen activator.

Case Description: On initial evaluation, patient was noted to have right hemiparesis, intermittent double vision, and impaired reading comprehension and written expression at a word level. He presented with alexia and agraphia as well as fluent aphasia with most notable deficits in anomia and semi-complex auditory comprehension abilities. Dysarthria was not present. During hospitalization, he received multidisciplinary rehabilitation and concurrent treatment addressing slow reading and spelling impairments. His speech therapy sessions were focused on circumlocution and re-auditorization strategies to improve verbal expression and auditory comprehension. Also, the patient used strategies of tracing to improve letter identification and word recognition.

Setting: Acute inpatient rehabilitation hospitalAssessment/

Results: After 4 weeks of treatment in an acute inpatient rehabilitation setting, patient was able to read and write at a sentence level with use of orally spelling words to dictation and to identify grapheme errors, as well as tracing letters for perceptive feedback to improve reading abilities.

Discussion: Concomitant alexia and agraphia is a uncommon presentation in patients with left PCA infarct. Extant research on the treatment of such a patient supports concurrent behavioral treatment protocol to address acquired reading and spelling deficits as an effective treatment strategy. Previous research also suggests that 6 weeks of treatment is an adequate duration to improve both reading and spelling in a patient with concomitant alexia and agraphia after a posterior cerebral artery infarct.

Conclusion: Alexia with agraphia is uncommon in patients with left PCA infarct and requires specific and unique rehabilitation treatment. The successful treatment of this case supports the effectiveness of combined simultaneous treatment to address reading and spelling in patients with alexia and agraphia associated with left posterior cerebral territory infarct.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/re-learning-your-abcs-treatment-of-concomitant-alexia-and-agraphia-in-a-patient-with-left-posterior-cerebral-artery-infarct-a-case-report/