Nonconvulsive status epilepticus manifesting as pure alexia (alexia without agraphia).

Pure alexia is a rare disorder usually caused by an ischemic or hemorrhagic stroke. We describe a case of pure alexia due to nonconvulsive status epilepticus (NCSE). This 57-year-old man presented in a hyperosmolar, nonketotic state with fluctuations in mental status and an inability to read. His EEG was diagnostic of NCSE originating from the left temporo-occipital region. MRI of the brain revealed increased FLAIR signal over the left occipitotemporal region. Following initiation of antiepileptic treatment, his neurological examination normalized concomitantly with resolution of the NCSE. A follow-up MRI scan of the brain obtained 1 month later was normal. NCSE can have unusual clinical manifestations, and a high index of suspicion is necessary to correctly diagnose these patients.