Pure alexia in Japanese and agraphia without alexia in kanji. The ability dissociation between reading and writing in kanji vs kana.

A 60-year-old right-handed Japanese man with infarction of the left occipital lobe and inferior temporal gyrus initially showed pure alexia in kana and kanji. Later, though pure alexia in kana persisted, his kanji reading improved markedly, but with little improvement of kanji writing. We speculate that different pathways are involved in kanji reading and writing. Wernicke's area and its surrounding left middle temporal lobe might play the most important role for kanji reading when visual information is transmitted by any pathway. The pathway from Wernicke's area to the left occipital lobe via the middle and inferior temporal pathway may be indispensable for kanji writing. We postulate "agraphia without alexia in kanji" due to left inferior temporal subcortical damage.