Acquired dyslexia in Spanish: a review and some observations on a new case of deep dyslexia

Readers and writers of Spanish use an orthography that is highly transparent. It has been proposed that readers of Spanish can rely on grapheme-phoneme correspondences, alone, to access meaning or phonology from print. In recent years, a number of case studies have yielded evidence inconsistent with this idea. We review these studies with particular focus on those that report evidence for reading based on direct lexical mappings between print, orthographic representations, and meaning or phonology. We report a new case of acquired literacy impairment in Spanish, MJ, who presents a pattern of preserved abilities and deficits symptomatic of deep dyslexia. The patient is unable to read nonwords, but can read a substantial number of words. Her reading is characterized by the production of semantic, visual, and derivational errors. We argue that MJ has a deficit in her lexical selection ability, common to both her reading and her naming problems. We propose that MJ, and the other cases we review, demonstrate that lexical reading is adopted by skilled readers even in a transparent language.     

A case of literal alexia: evidence for a disconnection syndrome

We describe a patient with literal alexia, agraphia, and only minimal aphasia, resulting from a left occipito-parietal ischemic infarction. Neither impaired visual processing nor impaired oral output could explain the patient's letter reading deficit, since he retained the ability to match letters of mixed case, and remained able to spell aloud and to pronounce and comprehend orally spelled words. His residual word reading was characterized by better performance for nouns and highly imageable words than for functors , poorly imageable words, and nonwords. We propose that this patient's letter reading deficit was due to a partial disconnection of his visual from his linguistic systems, with residual word reading accomplished by a semantically mediated compensatory mechanism. We suggest, further, that the dissociations between word and letter reading observed in some alexic individuals may be attributed, in part, to a difference in the relative contributions of dorsal and ventral occipital structures to the reading process.     

Covert reading of letters in a case of global alexia

This study describes the case of a global alexic patient with a severe reading deficit affecting words, letters and Arabic numbers, following a left posterior lesion. The patient (VA) could not match spoken letters to their graphic form. A preserved ability to recognize shape and canonical orientation of letters indicates intact access to the representation of letters and numbers as visual objects. A relatively preserved ability to match lowercase to uppercase letters suggests partially spared access to abstract letter identities independently of their visual forms. The patient was also unable to match spoken letters and numbers to their visual form, indicating that she could not access the graphemic representations of letters from their phonological representations. This pattern of performance suggests that the link between graphemic and phonological representations is disrupted in this patient. We hypothesize that VA’ residual reading abilities are supported by the right hemisphere.     

Iconic reading in a case of alexia without agraphia caused by a brain tumor: a tachistoscopic study

The lack of nonverbal reading comprehension in the clinical disconnection syndrome, alexia without agraphia, has been contradictory to the relative reading comprehension of the right hemisphere in split brains. We report a 39-year-old patient with verbal alexia without agraphia caused by brain tumor. On rapid tachistoscopic presentation of object names, he denied seeing anything but showed nonverbal reading comprehension by pointing to the corresponding objects. He lost this ability when he recovered ability to name individual letters of the object names. Our results suggest that even partial verbal reading such as the naming of single letters makes demonstration of iconic reading impossible and that total functional disconnection from verbalization, as initially noted in this case or in split brain studies, is necessary to show nonverbal reading comprehension.     

Selective alexia and agraphia sparing numbers-a case study

We report a patient (MT) with a highly specific alexia affecting the identification of letters and words but not numbers. He shows a corresponding deficit in writing: his letter writing is impaired while number writing and written calculation is spared. He has no aphasia, no visuo-perceptual or -constructional difficulties, or other cognitive deficits. A similar pattern of performance has to our knowledge only been reported once before [Anderson, S. W., Damasio, A. R., & Damasio, H. (1990). Troubled letters but not numbers. Domain specific cognitive impairments following focal damage in frontal cortex. Brain, 113, 749-766]. This study shows that letter and number reading are dependent on dissociable processes. More interestingly, it points to a common mechanism subserving the perception and production of letters. We suggest that a deficit in a visuo-motor network containing knowledge of the physical shape of letters might explain the pattern of performance displayed by MT.     

Comorbidity in compulsive hoarding: a case report

A 56-year-old male presented with compulsive hoarding along with attention-deficit/hyperactivity disorder and schizotypal personality disorder. Hoarding has been described as difficult to treat both pharmacologically and behaviorally, and this patient's comorbid conditions also contributed to his overall impairment. The patient's treatment regimen of fluvoxamine, amphetamine salts, and risperidone, along with behavioral therapy, has helped with hoarding behaviors, motivation, procrastination, and increased socialization. Hoarding may be a unique subtype of obsessive-compulsive disorder with poorer prognosis and distinct neuroanatomic dysfunction. Augmentation with stimulants may provide benefits in aspects of hoarding such as procrastination, especially in patients with comorbid attention-deficit hyperactivity disorder.     

Acquired aphasia with convulsive disorders in children: a case study with a seven-year follow-up.

In a 7-year follow-up a case of the “syndrome of acquired aphasia with convulsive disorder” is described. In particular, attention is paid to EEG patterns and linguistic analysis. Although seizures have been controlled medically and EEG abnormalities have tended to improve, no close parallel improvement has been observed in the patient's language disorders.     

Persistent autobiographical amnesia: a case report

We describe a 47-year-old man who referred to the Emergency Department for sudden global amnesia and left mild motor impairment in the setting of increased arterial blood pressure. The acute episode resolved within 24 hours. Despite general recovery and the apparent transitory nature of the event, a persistent selective impairment in recollecting events from some specific topics of his personal life became apparent. Complete neuropsychological tests one week after the acute onset and 2 months later demonstrated a clear retrograde memory deficit contrasting with the preservation of anterograde memory and learning abilities. One year later, the autobiographical memory deficit was unmodified, except for what had been re-learnt. Brain MRI was normal while H20 brain PET scans demonstrated hypometabolism in the right globus pallidus and putamen after 2 weeks from onset, which was no longer present one year later. The absence of a clear pathomechanism underlying focal amnesia lead us to consider this case as an example of functional retrograde amnesia.     

Crossed Wernicke's aphasia: a case report

Crossed aphasia is a phenomenon in which an individual sustains a lesion in the right hemisphere (typically non-language dominant), but who exhibits an aphasic syndrome. The authors present a case study of an individual with crossed aphasia (CA) in an attempt to provide anecdotal information for four questions posed by : (a). Is CA a reversal of the normal cerebral hemisphere pattern of language function? (b). Does the presence of aphasia following a right cerebral hemisphere lesion indicate that typical right hemisphere functions (e.g., visual perception) are intact? (c). How may the aphasia's presentation differ from typical left hemisphere aphasias? And (d). is the pattern of improvement following CA similar to that of typical left hemisphere aphasias? We longitudinally examined the communicative-cognitive performance of an adult man with crossed aphasia of the Wernicke's type following a cerebrovascular accident. A 21-week follow-up evaluation indicated improvements in his language functioning from our initial evaluation, but he continued to exhibit a classic, moderately severe Wernicke's aphasia.     

Subcortical anarthria: a case report.

A 56-year-old right-handed male with a history of hypertension and diabetes presented two episodes of stroke: The first affected territory was the left anterior coroidal artery (capsular and paracapsular infarcts at the level of the genu and posterior arm of the internal capsule) and the second was the right thalamus, due to a hematoma. Following the first stroke, the patient developed severe dysarthria and after the second stroke remained anarthric. The pathophysiology of the disorder is discussed, and the role of the left and right thalamus as far as speech is concerned is reviewed.     

Acquired stuttering following right frontal and bilateral pontine lesion: a case study

We report neurological information and experimental data regarding acquired neurogenic stuttering in a 57-year-old male following ischemic lesion to the orbital surface of the right frontal lobe and the pons. The experimental data consist of stuttering frequency measures under various conditions that are well known to enhance fluency in most individuals with developmental stuttering. Specifically, we report data for adaptation, unison reading, delayed auditory feedback (DAF), and frequency altered feedback (FAF). This work is the first published report of such a comprehensive examination of a variety of fluency-enhancing conditions in acquired stuttering. The patient read six 200-word texts under different conditions: Six solo readings (Text 1), five unison readings followed by five solo readings (Text 2), five readings with non-altered auditory feedback (Text 3), five readings with 50 ms delayed auditory feedback (Text 4), five readings with increased FAF (Text 5), and five readings with decreased FAF (Text 6). Results indicate that, unlike the typical situation for developmental stuttering, this individual with acquired neurogenic stuttering did not show increased fluency during an adaptation paradigm or under unison, DAF, and FAF conditions. We discuss possible implications of these findings and emphasize the need for further research on acquired neurogenic stuttering.     

Using morphology when spelling in a shallow orthographic system: The case of Spanish

Deep orthographies usually represent morphology and phonology simultaneously; both resources are necessary for spelling. In shallow orthographies, such as Spanish, phonology would be enough to spell most words. However, morphological knowledge may also take part in spelling. This study examined how Spanish children in 1st (N = 148), 2nd (N = 155) and 3rd grade (N = 155) use morphological information to spell plural nouns and verbs. A word dictation task was designed. The task included high and low frequency plural nouns ending in “s” (morphological “-s” condition) and verbs in the 2nd person ending in “s” (morphological “-s” condition). A lexical condition including words with a final “s” which was not morphologically motivated was used as a control condition (lexical “-s” condition). The results show that, although Spanish spelling is influenced by phonology, morphological information is also used. These results are discussed in relation to current models of word spelling.     

The evolution of pure alexia: a longitudinal study of recovery

This case report documents the partial recovery, over a 12-month period, of pure alexia in an adult female following a left occipital infarction. Measures of speed and accuracy were obtained on an oral reading and a lexical decision task immediately postonset and then on 10 subsequent occasions. Explicit letter-by-letter reading was observed only during the first week poststroke but a significant effect of word length was seen in all testing sessions. Reading accuracy was relatively good at all stages and reading latency showed a remarkable decrease over time but did not reach normal reading rates. The inability to use higher-order orthographic knowledge, as manifest in the absence of a word superiority effect, was still noted at one year postonset. We therefore concluded that the change in behavior was attributable to increased proficiency in the use of the adaptive letter-by-letter procedure rather than to the resolution of the underlying deficit. It is suggested that longitudinal neurobehavioral studies add to our understanding of the alexic deficit and provide insight into the recovery process.     

Age-of-acquisition effects in pure alexia

Pure alexia is an acquired reading disorder in which previously literate adults adopt a letter-by-letter processing strategy. Though these individuals display impaired reading, research shows that they are still able to use certain lexical information in order to facilitate visual word processing. The current experiment investigates the role that a word's age of acquisition (AoA) plays in the reading processes of an individual with pure alexia (G.J.) when other lexical variables have been controlled. Results from a sentence reading task in which eye movement patterns were recorded indicated that G.J. shows a strong effect of AoA, where late-acquired words are more difficult to process than early-acquired words. Furthermore, it was observed that the AoA effect is much greater for G.J. than for age-matched control participants. This indicates that patients with pure alexia rely heavily on intact top-down information, supporting the interactive activation model of reading.     

Age-of-acquisition effects in pure alexia

Pure alexia is an acquired reading disorder in which previously literate adults adopt a letter-by-letter processing strategy. Though these individuals display impaired reading, research shows that they are still able to use certain lexical information in order to facilitate visual word processing. The current experiment investigates the role that a word's age of acquisition (AoA) plays in the reading processes of an individual with pure alexia (G.J.) when other lexical variables have been controlled. Results from a sentence reading task in which eye movement patterns were recorded indicated that G.J. shows a strong effect of AoA, where late-acquired words are more difficult to process than early-acquired words. Furthermore, it was observed that the AoA effect is much greater for G.J. than for age-matched control participants. This indicates that patients with pure alexia rely heavily on intact top-down information, supporting the interactive activation model of reading.