The role of the intraparietal sulcus in numeracy: A review of parietal lesion cases.

Prominent theories of numeracy link the intraparietal sulcus (IPS) to approximate representations of quantity that undergird basic math abilities. The goal of this review is to better understand the neural basis of mathematical cognition through the lens of acalculia, by identifying numeracy-focused single case studies of patients with parietal lesions and testing for causal relationships between numeracy impairments and the locus of parietal damage. A systematic literature review identified 27 single case studies with left parietal lesions and categorized administered tasks across four numeracy domains: Approximation, Calculation, Ordinality/Cardinality, and Transcoding. We compared published lesion images by drawing a sphere at the inferred center-of-mass and assigning each case to an anatomical group (IPS or Other Parietal damage) based on overlap with left IPS and original anatomical description. We performed Fisher's Exact Test to compare behavioral performance on each numeracy domain between the two groups. As an exploratory follow-up, we used Activation Likelihood Estimation (ALE) to identify sites of damage within parietal cortex preferentially associated with impairments in each domain. We found that Approximation impairments were significantly more frequent in the IPS group (p = .003). The exploratory ALE analysis revealed that only Approximation impairment cases significantly overlapped with the IPS, while impairments in other domains were localized to different regions of the parietal lobe. Based on the pattern of impairments shown across these cases, we conclude that damage to the left IPS is linked to impairments in approximation ability specifically. Our findings support theoretical claims linking IPS to magnitude representation, but do not provide evidence that IPS critically underpins performance across all numeracy tasks. Instead, our findings are more compatible with models of dissociable circuits of numerical processing within the parietal lobe.