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Alexia is a rare neurological disorder characterized by the acquired inability to read, often accompanied by spared writing and speech abilities. This condition primarily arises from focal brain lesions affecting regions critical for visual word recognition and reading, including the occipital cortex, corpus callosum, and angular gyrus. The disorder manifests in several clinical subtypes such as pure alexia, alexia with agraphia, frontal alexia, and posterior alexia, each associated with distinct neuroanatomical and pathological features. Etiologies range from vascular insults like ischemic stroke to traumatic brain injury, neurodegenerative diseases including Alzheimer’s, as well as infectious, neoplastic, and demyelinating conditions. Clinically, alexia presents with deficits in word recognition and reading fluency while often preserving the ability to write and speak, accompanied by additional neurological symptoms such as hemianopia and aphasia. Diagnostic evaluation integrates detailed clinical and neuropsychological assessments with advanced neuroimaging techniques, including MRI, fMRI, and diffusion tensor imaging (DTI), to localize lesions and understand underlying mechanisms. Theoretical models of visual word processing and hemispheric language dominance provide frameworks for understanding alexia’s cognitive underpinnings. Therapeutic interventions emphasize speech and language therapy supported by emerging digital tools, with novel approaches including neuromodulation via transcranial magnetic stimulation and direct current stimulation showing promise. Recent advances in connectomics, machine learning, and brain-computer interfaces offer innovative avenues for rehabilitation and recovery. Despite progress, challenges such as underdiagnosis, limited access to specialized care, and lack of standardized protocols remain. This review synthesizes current knowledge on alexia, integrating neurobiological and behavioural perspectives, and highlights directions for future research to enhance diagnosis, treatment, and patient outcomes.