Finally, SM’s residual recognition ability appeared to be consistent with the response properties of right LOC and hV4. We localized SM’s structural lesion relative to retinotopically and functionally defined cortical areas. The lesion was situated within LOC, anterior to hV4 and dorsolateral to VO1/2, and was confined to a circumscribed region in the posterior part of the lateral fusiform gyrus in the RH. Typically, this region responds more to intact objects than scrambled objects (Malach et al., 1995) and damage to this circumscribed area is likely the principle etiology Alectinib nmr of SM’s object agnosia. The precise relationship between lesion localization and agnosia

has been difficult to establish to date. For example, although the lesion site of patient DF, a well-known agnosic patient who suffered a hypoxic episode (James et al., 2003), has been well documented in anatomical terms, the lesion was not sited relative to retinotopic cortex. Moreover, DF’s lesion is much more distributed than SM’s, implicating bilateral damage of ventral occipitotemporal cortex. A similar profile has been reported for agnosic patient JS, whose etiology is one of ischemic stroke; like DF, the extent of the brain

damage was extensive and bilateral (Karnath et al., 2009) making it difficult to pinpoint the critical area underlying object recognition. Fludarabine solubility dmso Our results suggest a resolution to the ongoing controversy regarding whether a unilateral or bilateral lesion is necessary for agnosia (De Renzi, 2000). As we show, a structural unilateral RH may suffice for object agnosia but because of the detrimental functional effect on the LH, the outcome essentially mimics a bilateral lesion. This finding raises important issues about Edoxaban whether the focal lesion per se serves as the underpinning of the disorder or whether a reconceptualization in terms of a more distributed neural system might be a better formulation. The first functional finding concerns the normal retinotopy obtained in SM. Although retinotopic maps can be altered extensively

in individuals post-stroke (Dilks et al., 2007), this is not so in SM. Critically, the intact retinotopy in SM precludes the ascription of any altered functionality to a foundational problem such as altered topographical organization. In addition, SM’s visual responses were relatively unperturbed, although object-related responses were reduced in temporal and parietal regions. Consistent with this, there was a reduction in the AIs across the range of object types not only in the region of the lesion, but also in other sectors of the rectangular grid. There is growing recognition that visuoperceptual impairments may arise from lesions to nodes of a distributed ventral occipitotemporal circuit, but also from a disconnection between more posterior and more anterior cortical regions.