Alexia without agraphia in a composer

A 77-year-old composer had a left occipital lobe haemorrhagic infarct giving a severe reading disturbance with well-preserved writing and without appreciable aphasia. He continued to read music and to compose. His text- and music-reading performance under different conditions suggests that this unusual dissociation was primarily due to four factors. (1) He was unusually talented musically and inferred a great deal about the music he was reading. (2) The symbols of staff music notation are more visually distinctive than the symbols of phonetic language writing systems. (3) In staff music notation, pitch is represented ordinally, and other symbols are also distinguishable by their relative positions and sizes. (4) Music notation can be usefully read by interpreting it acoustically, kinaesthetically or in terms of formal musical concepts; in contrast to written language, it need not be interpreted referentially or in terms of auditory-verbal images. His disorder fits the classic visual-verbal disconnection account of alexia without agraphia and the contemporary view that music involves a family of related but distinct skills probably involving many brain areas in both hemispheres, although different cortical areas make characteristic contributions to different musical behaviours.