Right homonymous hemianopsia with a right visual field defect and alexia without agraphia. Which stroke territory?

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Multiple Choice

Right homonymous hemianopsia with a right visual field defect and alexia without agraphia. Which stroke territory?

Pattern recognition in neuroanatomy shows that a right visual field loss in both eyes points to a lesion on the left side along the posterior visual pathways. The additional finding of alexia without agraphia specifically implicates disruption of the left hemisphere’s reading network, typically in the occipitotemporal region supplied by the left posterior cerebral artery (PCA). When the left PCA territory is affected, you can see a right homonymous hemianopsia from involvement of the left occipital cortex or optic radiations, together with alexia (reading trouble) while writing remains intact because the writing system stays connected to language centers. That combination is most consistent with a left PCA stroke. The other territories don’t fit as well: a right PCA stroke would produce left visual field loss, MCA involvement would more often cause aphasia and different visual or language deficits, and ACA stroke would not produce this pattern of visual-field loss with alexia without agraphia.

Pattern recognition in neuroanatomy shows that a right visual field loss in both eyes points to a lesion on the left side along the posterior visual pathways. The additional finding of alexia without agraphia specifically implicates disruption of the left hemisphere’s reading network, typically in the occipitotemporal region supplied by the left posterior cerebral artery (PCA). When the left PCA territory is affected, you can see a right homonymous hemianopsia from involvement of the left occipital cortex or optic radiations, together with alexia (reading trouble) while writing remains intact because the writing system stays connected to language centers. That combination is most consistent with a left PCA stroke. The other territories don’t fit as well: a right PCA stroke would produce left visual field loss, MCA involvement would more often cause aphasia and different visual or language deficits, and ACA stroke would not produce this pattern of visual-field loss with alexia without agraphia.

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