Reading words, seeing style: the neuropsychology of word, font and handwriting perception

The reading of text is predominantly a left hemisphere function. However, it is also possible to process text for attributes other than word or letter identity, such as style of font or handwriting. Anecdotal observations have suggested that processing the latter may involve the right hemisphere. We devised a test that, using the identical stimuli, required subjects first to match on the basis of word identity and second to match on the basis of script style. We presented two versions, one using various computer fonts, and the other using the handwriting of different individuals. We tested four subjects with unilateral lesions who had been well characterized by neuropsychological testing and structural and/or functional MRI. We found that two prosopagnosic subjects with right lateral fusiform damage eliminating the fusiform face area and likely the right visual word form area were impaired in completion times and/or accuracy when sorting for script style, but performed better when sorting for word identity. In contrast, one alexic subject with left fusiform damage showed normal accuracy for sorting by script style and normal or mildly elevated completion times for sorting by style, but markedly prolonged reading times for sorting by word identity. A prosopagnosic subject with right medial occipitotemporal damage sparing areas in the lateral fusiform gyrus performed well on both tasks. The contrast in the performance of patients with right versus left fusiform damage suggests an important distinction in hemispheric processing that reflects not the type of stimulus but the nature of processing required.