Ideographic Alexia without Involvement of the Fusiform Gyrus in a Korean Stroke Patient: A Serial Functional Magnetic Resonance Imaging Study

BACKGROUND: Korean orthography is composed of Hanja (ideograms) and Hangul (phonograms). Based on previous studies, the fusiform gyrus has been associated with ideogram reading. We examine serial functional magnetic resonance imaging (fMRI) images in a patient exhibiting dissociation of Hanja and Hangul reading to identify brain areas associated with Hanja reading. CASE REPORT: fMRI were taken of a 63-year-old man showing profound Hanja alexia with normal Hangul reading after an acute stroke involving the left frontal and parietal lobes, who later spontaneously recovered his Hanja reading ability. Scans were taken while performing Hanja and Hangul reading tasks on three occasions. As a result, in spite of having profound Hanja alexia, partial activation of the fusiform gyrus was observed on the first fMRI. Serial fMRI scans showed activation of the bilateral middle frontal gyri that increased in parallel with the patient's recovery of Hanja reading. CONCLUSIONS: The frontal lobe, not only fusiform gyrus, may play role in reading Hanja, although more evidence is needed.