Understanding the functional neuroanatomy of acquired prosopagnosia

One of the most remarkable disorders following brain damage is prosopagnosia, the inability to recognize faces. While a number of cases of prosopagnosia have been described at the behavioral level, the functional neuroanatomy of this face recognition impairment, and thus the brain regions critically involved in normal face recognition, has never been specified in great detail. Here, we used anatomical and functional magnetic resonance imaging (fMRI) to present the detailed functional neuroanatomy of a single case of acquired prosopagnosia (PS; Rossion, B., Caldara, R., Seghier, M., Schuller, A.-M., Lazeyras, F., Mayer, E., 2003a. A network of occipito-temporal face-sensitive areas besides the right middle fusiform gyrus is necessary for normal face processing. Brain 126, 2381-95; Rossion, B., Joyce, C.A., Cottrell, G.W., Tarr, M.J., 2003b. Early lateralization and orientation tuning for face, word, and object processing in the visual cortex. Neuroimage 20, 1609-24) with normal object recognition. First, we clarify the exact anatomical location and extent of PS' lesions in relation to (a) retinotopic cortex, (b) face-preferring regions, and (c) other classical visual regions. PS' main lesion - most likely causing her prosopagnosia - is localized in the posterior part of the right ventral occipitotemporal cortex. This lesion causes a left superior paracentral scotoma, as frequently observed in cases of prosopagnosia. While the borders of the early visual areas in the left hemisphere could be delineated well, the extensive posterior right-sided lesion hampered a full specification of the cortical representation of the left visual field. Using multiple scanning runs, face-preferring activation was detected within the right middle fusiform gyrus (MFG) in the so-called 'fusiform face area' ('FFA'), but also in the left inferior occipital gyrus (left 'OFA'), and in the right posterior superior temporal sulcus (STS). The dorsal part of the lateral occipital complex (LOC) and the human middle temporal cortex (hMT+/V5) were localized bilaterally. The color-preferring region V4/V8 was localized only in the left hemisphere. In the right hemisphere, the posterior lesion spared the ventral part of LOC, a region that may be critical for the preserved object recognition abilities of the patient, and the restriction of her deficit to the category of faces. The presumptive functions of both structurally damaged and preserved regions are discussed and new hypotheses regarding the impaired and preserved abilities of the patient during face and non-face object processing are derived. Fine-grained neurofunctional analyses of brain-damaged single cases with isolated recognition deficits may considerably improve our knowledge of the brain regions critically involved in specific visual functions, such as face recognition.