Transcortical alexia with agraphia following a right temporo-occipital hematoma in a right-handed patient

Delineating the cognitive-neural substrates of writing: a large scale behavioral and voxel based morphometry study

The current study investigated the cognitive and neural substrates that underpin writing ability. We explored similarities and differences in writing numbers and words and compared these to language and manual actions in a large group of sub-acute, stroke patients (n = 740). The behavioral data showed association and dissociation in the ability to write words and numbers. Comorbidities of writing deficits with both language and motor impairments were prevalent, with less than a handful showing deficits restricted to the writing tasks. A second analysis with a subset of patients (n = 267) explored the neural networks that mediate writing abilities. Lesion to right temporal contributed to writing words, while lesions to left postcentral contributed to writing numbers. Overlapping neural mechanisms included the bilateral prefrontal cortex, right inferior parietal, left middle occipital and the right cerebellum. With the former regions associated with error pattern typical to writing based on prior knowledge (the lexical route), while lesion to left MOG was associated with errors to the phonological (non-lexical) route. Using principle components extracted from the behavioral data, we showed that right prefrontal and right parietal contributed to the ability to use pen, while lesion to bilateral prefrontal, inferior temporal and cerebellum supported unique use of pen for writing. The behavioral and imaging data suggested that writing numbers and words primarily relied on overlapping cognitive and neural functions. Incidents of pure writing deficits, in the absence of motor or language deficits were rare. Nevertheless, the PCA and neural data suggested that writing abilities were associated with some unique neuro-cognitive functions, specifically dedicated to the use of pen and the ability to transform meaning to motor command.

Neuromagnetic correlates of hemispheric specialization for face and word recognition

The adult human brain appears to have specialized and independent neural systems for the visual processing of faces and words: greater selectivity for faces in the right hemisphere (RH) while greater selectivity for words in the left hemisphere (LH). Nevertheless, the nature of functional differences between the hemispheres is still largely unknown. To elucidate the hemispheric specialization for face and word recognition, event-related magnetic fields (ERFs) were recorded in young adults while they passively viewed faces and words presented either in the right visual field or in the left visual field. If the neural correlates of face recognition and word recognition reflect the same lateralization profile, then the lateralization of the magnetic source of the M170 component should follow a similar profile, with a greater M170 response for faces in the RH and a greater M170 response for words in the LH. We observed the expected finding of a larger M170 in the LH for words. Unexpectedly, a larger M170 response in the RH for faces was not found. Thus, the hemispheric organization of face recognition is different from that of word recognition in terms of specificity.

Face and Word Recognition Can Be Selectively Affected by Brain Injury or Developmental Disorders

Face and word recognition have traditionally been thought to rely on highly specialised and relatively independent cognitive processes. Some of the strongest evidence for this has come from patients with seemingly category-specific visual perceptual deficits such as pure prosopagnosia, a selective face recognition deficit, and pure alexia, a selective word recognition deficit. Together, the patterns of impaired reading with preserved face recognition and impaired face recognition with preserved reading constitute a double dissociation. The existence of these selective deficits has been questioned over the past decade. It has been suggested that studies describing patients with these pure deficits have failed to measure the supposedly preserved functions using sensitive enough measures, and that if tested using sensitive measurements, all patients with deficits in one visual category would also have deficits in the other. The implications of this would be immense, with most textbooks in cognitive neuropsychology requiring drastic revisions. In order to evaluate the evidence for dissociations, we review studies that specifically investigate whether face or word recognition can be selectively affected by acquired brain injury or developmental disorders. We only include studies published since 2004, as comprehensive reviews of earlier studies are available. Most of the studies assess the supposedly preserved functions using sensitive measurements. We found convincing evidence that reading can be preserved in acquired and developmental prosopagnosia and also evidence (though weaker) that face recognition can be preserved in acquired or developmental dyslexia, suggesting that face and word recognition are at least in part supported by independent processes.

The brain adapts to orthography with experience: evidence from English and Chinese

Using functional magnetic resonance imaging (fMRI), we examined the process of language specialization in the brain by comparing developmental changes in two contrastive orthographies: Chinese and English. In a visual word rhyming judgment task, we found a significant interaction between age and language in left inferior parietal lobule and left superior temporal gyrus, which was due to greater developmental increases in English than in Chinese. Moreover, we found that higher skill only in English children was correlated with greater activation in left inferior parietal lobule. These findings suggest that the regions associated with phonological processing are essential in English reading development. We also found greater developmental increases in English than in Chinese in left inferior temporal gyrus, suggesting refinement of this region for fine-grained word form recognition. In contrast, greater developmental increases in Chinese than in English were found in right middle occipital gyrus, suggesting the importance of holistic visual-orthographic analysis in Chinese reading acquisition. Our results suggest that the brain adapts to the special features of the orthography by engaging relevant brain regions to a greater degree over development.

A vision of graded hemispheric specialization

Understanding the process by which the cerebral hemispheres reach their mature functional organization remains challenging. We propose a theoretical account in which, in the domain of vision, faces and words come to be represented adjacent to retinotopic cortex by virtue of the need to discriminate among homogeneous exemplars. Orthographic representations are further constrained to be proximal to typically left-lateralized language-related information to minimize connectivity length between visual and language areas. As reading is acquired, orthography comes to rely more heavily (albeit not exclusively) on the left fusiform region to bridge vision and language. Consequently, due to competition from emerging word representations, face representations that were initially bilateral become lateralized to the right fusiform region (albeit, again, not exclusively). We review recent research that describes constraints that give rise to this graded hemispheric arrangement. We then summarize empirical evidence from a variety of studies (behavioral, evoked response potential, functional imaging) across different populations (children, adolescents, and adults; left handers and individuals with developmental dyslexia) that supports the claims that hemispheric lateralization is graded rather than binary and that this graded organization emerges dynamically over the course of development. Perturbations of this system either during development or in adulthood provide further insights into the principles governing hemispheric organization.

Distributed circuits, not circumscribed centers, mediate visual recognition

Increasingly, the neural mechanisms that support visual cognition are being conceptualized as a distributed but integrated system, as opposed to a set of individual, specialized regions that each subserve a particular visual behavior. Consequently, there is an emerging emphasis on characterizing the functional, structural,and computational properties of these broad networks [corrected]. We present a novel theoretical perspective, which elucidates the developmental emergence, computational properties, and vulnerabilities of integrated circuits using face and word recognition as model domains. Additionally, we suggest that, rather than being disparate and independent, these neural circuits are overlapping and subject to the same computational constraints. Specifically, we argue that both word and face recognition rely on fine-grained visual representations but, by virtue of pressure to couple visual and language areas and to keep connection length short, the left hemisphere becomes more finely tuned for word recognition and, consequently, the right hemisphere becomes more finely tuned for face recognition. Thus, both hemispheres ultimately participate in both forms of visual recognition, but their respective contributions are asymmetrically weighted.

Bilateral hemispheric processing of words and faces: evidence from word impairments in prosopagnosia and face impairments in pure alexia

Considerable research has supported the view that faces and words are subserved by independent neural mechanisms located in the ventral visual cortex in opposite hemispheres. On this view, right hemisphere ventral lesions that impair face recognition (prosopagnosia) should leave word recognition unaffected, and left hemisphere ventral lesions that impair word recognition (pure alexia) should leave face recognition unaffected. The current study shows that neither of these predictions was upheld. A series of experiments characterizing speed and accuracy of word and face recognition were conducted in 7 patients (4 pure alexic, 3 prosopagnosic) and matched controls. Prosopagnosic patients revealed mild but reliable word recognition deficits, and pure alexic patients demonstrated mild but reliable face recognition deficits. The apparent comingling of face and word mechanisms is unexpected from a domain-specific perspective, but follows naturally as a consequence of an interactive, learning-based account in which neural processes for both faces and words are the result of an optimization procedure embodying specific computational principles and constraints.

[Pure agraphia with topographical disorientation caused by right hemisphere lesion]

A 69-year-old, right-handed, Japanese male patient presented with pure agraphia with topographical disorientation after hemorrhage in the right parietal lobe. Upon developing cerebral hemorrhage, he was referred to our hospital for close examination of agraphia. There was no paresis or clumsiness in his extremities. His speech was fluent and well-articulated. Neither aphasia nor reading impairments was found, although there was a clear writing impairment with effort and hesitation. His writing of both kanji and kana letters contained additional, absent or deformed strokes or parts. No hemianopia, prosopagnosia, constructional disturbances and dressing apraxia were found. He could recognize familiar buildings or landscapes, but often lost his way around well-known areas. MR images revealed subcortical lesions of precuneus, superior and inferior parietal lobules in the right hemisphere, around the posterior horn of the lateral ventricle. He revealed pure agraphia and topographical disorientation after the right brain haemorrhage, without dementia or personality change. These findings indicate that the right parietal lobe participates in the kinesthetic movements of writing. Some authers have been documented cases of aphasic agraphia or alexia with agraphia caused by right hemisphere damage in dextrals, but pure agraphia caused by the lesion in the right hemisphere is very rare.

Large Acute Cerebral Hemorrhage Presenting With Pure Alexia

Alexia (the acquired inability to read) is an uncommon presenting complaint in the emergency department (ED). It is usually associated with a lesion in the brain located within the dominant hemisphere near the parieto-occipital junction, with some involvement of the splenium of the corpus callosum. Our review of the literature revealed multiple distinct causes for the finding of alexia, and a majority of the cases uncovered also involved agraphia (the acquired inability to write) and frequently visual field defects. We present the case of an otherwise healthy 35-year-old white man who arrived at our ED with the chief complaint of having difficulty reading. He was, however, able to write, and he exhibited no defects in his visual fields on gross testing in our ED. The patient was found to have a large, acute, intraparenchymal hemorrhage in the right posterior/inferior parietal cortex, very near the occipital lobe. We present this case, followed by a brief discussion, to heighten awareness of the complaint of alexia with or without agraphia as a possible presenting symptom of intracranial hemorrhage, or ischemic cerebrovascular accident.

Crossed aphasia: an analysis of the symptoms, their frequency, and a comparison with left-hemisphere aphasia symptomatology

This study presents a thorough analysis of published crossed aphasia (CA) cases, including for the first time the cases published in Japanese. The frequency of specific symptoms was determined, and symptomatology differences based on gender, familial sinistrality, and CA subtype were investigated. Results suggested that the CA population is comparable to the left-hemisphere patient population. However, male were significantly more likely than female CA subjects to show a positive history of familial sinistrality. Typical right-hemisphere (i.e., nonlanguage-dominant) symptoms were frequent but rarely carefully reported or assessed. Results are compared with previous CA reviews and left-hemisphere aphasia. Suggestions for a more systematic assessment of the CA symptomatology are presented.

Reading of Japanese Kanji (morphograms) and Kana (syllabograms): a magnetoencephalographic study

Magnetoencephalograms were recorded from six healthy Japanese subjects in order to investigate the areas in the cortices which are involved in the recognition of Japanese characters (Kanji and Kana). Forty-four Kanji (morphograms), 44 Kana (syllabograms) and 20 alphabet letters were used as stimuli. They were presented randomly and the subjects were required to read each stimulus and count the number of letters. The magnetic responses were recorded with dual 37-channel SQUID (Superconducting Quantum Interference Device) gradiometers from the temporal, parietal and occipital areas of the brain. The magnetic responses to Kanji and Kana were similar and consequently the locations of equivalent current dipoles (ECDs) to Kanji and those to Kana did not differ at any recording site. In all the subjects, ECDs were found in the posterior inferior temporal (PIT) areas approximately corresponding to Brodmann area 37 in the latency range of 150-300 msec. These activities were found in both hemispheres without consistent laterality. The location of the ECD moved forward from posterior to anterior in the PIT area as the latency increased in all but one subject. Only one subject showed activities in the left angular gyrus. Since activities in PIT areas were also found in alphabet letters, the bilateral PIT areas are considered to play an essential role in reading.