Reading Problems After Stroke or Head Injury

Until I feared I would lose it, I never loved to read. One does not love breathing."
               — Harper Lee

Reading difficulty may occur from various problems after a stroke or other acquired brain injury. Reading problems are a primary reason that stroke and head injury patients seek an eye examination. It is crucial that the type of reading problem be diagnosed. The list below contains some of the more common causes in reading problems with an introduction to how they may be treated.

Hemianoptic Alexia (Hemianoptic Dylexia): Reading Problems owing to the Visual Field Loss

Homonymous hemianopsia patients often lose their place in reading owing to their visual field loss. Wilbrand in 1907 coined this as macular-hemianoptic reading disorder and today we refer to it as hemianoptic alexia or hemianoptic dyslexia. These patients have the ability to read words, but complain that its just too difficult or confusing to read for long periods of time and that they now avoid it. They may report that they lose their place or get confused on which word to read next. Simple techniques, like sticking a Post-it note along the side of a column of print to mark the beginning or end of the column which reduces confusion can help. Techniques depend on whether a right or left hemianopsia is present.

Right Hemianopsia Reading: In a right hemianopsia patient, the blind spot of the field loss moves with the patient down the line of text like a curtain hidding what the patient is trying to read next. If there is little or no sparing of the macula (central vision), then the blindspot may not only block the end of the line of text making it difficult to locate the end of the line, but may block the end of long words. A patient may see the word "boathouse" as "boat" then after shifting fixation realize the word was actually "boathouse." The patient frequently becomes frustrated and gives up reading.

Boundary marking devices which we will discuss below and training the patient to read by looking at the last letter in long words can help improve reading in many patients with hemianoptic alexia. Patients with right hemianopsias may also have not only hemianoptic alexia, but could have a true alexia that limits reading due to cognitive processing of reading. This must be ruled out. This can be screened for by asking the patient to read and direct their fixation to the end of words or turning the print 90 degrees and ask them to read the text. The text should be turned clockwise vertically for right hemianopsia patients.

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