Phonologic Text Alexia

Some patients complain of difficulty reading following a stroke or head injury, but the examiner may be unable to find any class of words—or indeed any words at all—that the patient cannot read correctly. However, the accurate reading of words presented singly is not replicated when the words are presented within the context of text. When reading text, these patients tend to produce functor word substitutions, and they make errors on affixed words, as is frequently observed when phonological/deep alexic patients are asked to read single words. Also, like phonological alexic patients, these patients have difficulty reading pseudowords. It therefore appears that the reading problems of these patients are related to the problems seen in patients with phonological alexia. Hence, this reading disorder has been labeled phonologic text alexia.

Patients with phonologic text alexia typically have auditory comprehension deficits as well as reading comprehension deficits. They also have impaired short-term phonologic memory, as demonstrated by decreased span for recall of digits, words, and pseudo-words. The combination of all symptoms associated with phonologic text alexia leads to the proposition that the reading disorder seen in these patients is in some way the result of a deficit in phonologic processing and/or retention of phonologic information.

The paralexias produced by patients with phonologic text alexia in text reading (few errors are produced in single-word reading) are predominantly derivational paralexias and orthographic paralexias; semantic paralexias are not part of this syndrome, nor are regularization errors. A length effect may be observed, but this will be dependent on the number of syllables, not the number of letters, reflecting the phonologic processing deficit.

As with phonological alexia, phonological text alexia is normally the result of a lesion in the distribution of the left middle cerebral artery.

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