Prosopagnosia and agnosia for noncanonical views. An autopsied case

It has been postulated that for prosopagnosia to occur, bilateral lesions of the central visual system are usually necessary. All but 1 of the 10 previously documented cases that came to autopsy showed this pattern. However, the long survival period after the onset of prosopagnosia in most of these patients limits the value of the autopsy findings for clinicopathological correlation. A patient is presented who died 10 days after she had developed prosopagnosia, topographagnosia and an agnosia for real objects seen from noncanonical views. These clinical symptoms corresponded directly to the autopsy finding of a recent large occipitotemporal ischaemic infarct in the territory of the right posterior cerebral artery. An additional right frontal infarct and a cortical microinfarct in a deep left lateral parieto-occipital sulcus were both old lesions and had passed unnoticed clinically. This first report of a direct clinicopathological correlation between a fresh right posterior lesion and prosopagnosia demonstrates that bilateral involvement of the visual system is not a prerequisite for prosopagnosia.