Abstract

We describe the case of a child who developed an associative visual agnosia and document her neuropsychological and neuroimaging progression over the past 7 years. AR contracted a viral encephalitis at age 9 that destroyed the right temporal lobe and a portion of the left inferotemporal region. A triad of symptoms was observed: associative visual agnosia, prosopagnosia and color agnosia. With time, AR has shown limited behavioral improvement. Neuroimaging showed that, apart from the initial ‘normal’ findings, the neuroanatomical correlates remained stable over time. Strikingly, a clear dissociation between object and spatial representations is present in this patient, which is the basis for her apparent recovery of function. Indeed, she uses spatial as well as local cues to compensate for her recognition deficits. AR's inability to recognize objects is interpreted as a deficit in the inferior temporal ventral pathway specialized for object perception, whereas the posterior parietal dorsal pathway specialized for spatial localization remains functional. The contribution of the residual contralateral temporal lobe seems to account for her use of discrete details in visual recognition. Finally, the limited recovery displayed by AR indicates limits in cerebral plasticity for visual processes mediated by the right temporal lobe.