Right hemisphere reading mechanisms in a global alexic patient.

We investigated the implicit, or covert, reading ability of a global alexic patient (EA) to help determine the contribution of the right hemisphere to reading. Previous studies of alexic patients with left hemisphere damage have suggested that the ability to derive meaning from printed words that cannot be read out loud may reflect right hemisphere reading mechanisms. Other investigators have argued that residual left hemisphere abilities are sufficient to account for implicit reading and moreover do not require the postulation of a right hemisphere system that has no role in normal reading processes. However, few studies have assessed covert reading in patients with lesions as extensive as the one in EA, which affected left medial, inferior temporal-occipital cortex, hippocampus, splenium, and dorsal white matter. EA was presented with lexical decision, semantic categorization, phonemic categorization, and letter matching tasks. Although EA was unable to access phonology and could not overtly name words or letters, she was nevertheless capable of making lexical and semantic decisions at above chance levels, with an advantage for concrete versus abstract words. Her oral and written spelling were relatively intact, suggesting that orthographic knowledge is retained, although inaccessible through the visual modality. Based on her ability to access lexical and semantic information without contacting phonological representations, we propose that EA's implicit reading emerges from, and is supported, by the right hemisphere. Finally, we conclude that her spelling and writing abilities are supported by left hemisphere mechanisms.