When a rose is a rose in speech but a tulip in writing

We report the pattern of performance on language tasks by a neurologically impaired patient, RCM, who makes semantic errors in writing to dictation and in written naming, but makes very few errors at all (and no semantic errors) in spoken naming, oral reading, or spontaneous speech. RCM also shows a significant effect of concreteness on spelling accuracy and other features of so-called "deep dysgraphia." However, it is shown that, unlike previously reported patients described as deep dysgraphic, RCM has intact semantic processing but impairment in accessing lexical-orthographic representations, at least for the items tested. These results demonstrate that the collection of features labelled as "deep dysgraphia" can arise from damage to different cognitive processes. Detailed analyses of RCM's performance across lexical tasks, at two different time periods of recovery, provide evidence that lexical orthographic representations can be either directly activated by lexical semantic representations, or activated by the interaction of lexical semantic and sublexical information from phonology-to-orthography conversion mechanisms.