Patient MW: transient visual hemi-agnosia

  • Thomas Decramer
  • Elsie Premereur
  • Lieven Lagae
  • Johannes van Loon
  • Peter Janssen
  • Stefan Sunaert
  • Tom Theys
Original Communication


The concept of functional modularity in human visual processing was proposed 25 years ago with the distinction between a ventral pathway for object recognition and a dorsal pathway for action processing. Lesions along these pathways yield selective deficits. A 15-year-old patient (MW) presented with a seizure due to a lesion in the left occipitotemporal cortex. Surgical resection of the lesion was performed with sparing of the classic language areas and visual fields. Postoperatively MW had great difficulty reading and had a specific agnosia for more complex visual stimuli in the right hemifield. No deficit was seen for lower level visual discrimination tasks. Gradual improvement of hemi-agnosia was paralleled by slower reaction times reflecting a speed–accuracy trade-off. Absolute reading speed improved markedly over time, doubling at 6 weeks. MW fully recovered after 18 months. Postoperative functional Magnetic Resonance Imaging (fMRI) illustrated an overlap of the lesion with object and word processing areas. Diffusion Tensor Imaging showed damage to the white matter tracts [inferior fronto-occipital fasciculus and inferior longitudinal fasciculus (ILF)] interconnecting ventral temporal areas. A transient higher order deficit can result from a disruption of the neural network supporting visual word and object processing. Most visual system research has focused on cortical areas, while the underlying subcortical network received much less attention. We believe that white matter tracts, in particular the ILF, play a critical role in object perception by connecting visual areas along the ventral visual stream. Lesions of the ILF should be taken into consideration in agnosia.


Occipitotemporal cortex Visual agnosia Visual pathways Visual perception Reading Visual processing Ventral visual pathway 



Tom Theys is a Senior Clinical Investigator of FWO Flanders (FWO 1830717N).

Compliance with ethical standards

Conflicts of interest

All authors report no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Neurosciences, Research Group Experimental Neurosurgery and NeuroanatomyKU LeuvenLeuvenBelgium
  2. 2.Laboratory for Experimental Neuro- and Psychophysiology, Department of NeurosciencesKU LeuvenLeuvenBelgium
  3. 3.Department of PediatricsUniversity Hospitals LeuvenLeuvenBelgium
  4. 4.Department of Imaging and Pathology, Translational MRIKU LeuvenLeuvenBelgium

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