Covert reading of letters in a case of global alexia

This study describes the case of a global alexic patient with a severe reading deficit affecting words, letters and Arabic numbers, following a left posterior lesion. The patient (VA) could not match spoken letters to their graphic form. A preserved ability to recognize shape and canonical orientation of letters indicates intact access to the representation of letters and numbers as visual objects. A relatively preserved ability to match lowercase to uppercase letters suggests partially spared access to abstract letter identities independently of their visual forms. The patient was also unable to match spoken letters and numbers to their visual form, indicating that she could not access the graphemic representations of letters from their phonological representations. This pattern of performance suggests that the link between graphemic and phonological representations is disrupted in this patient. We hypothesize that VA' residual reading abilities are supported by the right hemisphere.