Recognition of stroke symptoms remains a barrier to early access to hyperacute stroke therapies. With an increasing use of mobile devices, an understanding of deficits related to use of technology is important. Dystextia and dystypia, an inability to text or type words, respectively, have been recognised as early stroke symptoms in various case reports.
An 86-year-old retired female teacher, presented with a 3-day history of difficulty reading text messages on her smartphone. Visual acuity was unchanged at 6/12 bilaterally, visual field examination revealed a right homonymous superior quadrantanopia, and an acquired alexia was present. There were no extraocular movement abnormalities, no prosopagnosia, no evidence of receptive, expressive or conductive dysphasia, and no agraphia or dystextia. CT brain demonstrated a subacute left temporooccipital infarct, with nil abnormalities on CTA. MRI brain confirmed diffusion restriction within the temporooccipital region consistent with a PCA territory infarct. The patient was outside the window for thrombolytic treatment. She underwent speech and language community rehabilitation, with mild improvement in her alexia, and developed strategies for managing the loss of function.
This case highlights the importance of modern technology in early recognition of stroke. Inability to read, with preserved ability to write text messages are an unusual modern-day presentation of pure alexia. In this case the deficit was secondary to a PCA territory infarct, detected outside the window for acute intervention.