We describe a patient with multiple brain lesions who presents with striking dissociations between verbal and manual responses in a variety of tasks, including visual extinction, recognition of digits and number words, and single-digit addition. Interpreted in light of other patient studies (e.g., Brion & Jedynak, 1972;Funnell et al., 2000;Baynes et al., 1997;Kamaki et al., 1993; Marchetti & Della Sala, 1998;Gazzaniga, 2000), these dissociations have implications for the understanding of righthemisphere language capacities, inter-hemispheric communication, and perhaps even consciousness.
Case HistoryWS is a 63-year-old right-handed man with a master's degree in mathematics. He worked as a math instructor at a community college before suffering CVAs in 1998 and 2000. MRI following the more recent incident revealed a new left parietal infarct, older left occipital and anterior callosal lesions, and possible thinning of other callosal regions. A right homonymous hemianopia was present immediately after the earlier CVA, but cleared within six months. At the time of the present study WS had normal acuity and visual fields.
Visual ExtinctionAsterisks were presented for 200 ms on a computer monitor. For Left stimuli, a single asterisk was presented to the left of fixation, and for Right stimuli an asterisk was presented to the right of fixation. For Both stimuli, an asterisk was presented both to the left and to the right of fixation.On each trial WS indicated where asterisks had appeared. In the Verbal Response condition he responded by saying ''left,'' ''right,'' or ''both.'' In the Manual Response condition he responded with his right hand, raising his index finger to indicate a Left stimulus, his middle finger for a Right stimulus, and both fingers for a Both stimulus.Results for the Verbal Response condition suggested left neglect with extinction. Whereas WS was 100% correct for Right stimuli (68/68), his accuracy was only 76% for Left stimuli (52/68), and 46% for Both stimuli (63/136). Virtually all of his errors involved failure to report asterisks presented on the left.In the Manual Response condition the results were quite different. Accuracy for Left stimuli (98% (51/52)-and Both stimuli-82% (85/104)) was much higher than in the Verbal Response condition (p Ͻ .001). Also, the majority of errors for Both stimuli (13/19) were failures to report the right stimulus, suggesting a mild right extinction. Accuracy for Right stimuli was 94% (49/52).
Digit RecognitionOn each trial a single digit was presented for 200 ms to the left or right of fixation. On Left and Right trials only the digit was presented; on Left-with-X and Rightwith-X trials an X was also presented, on the opposite side of fixation from the digit (see Table 1).WS was instructed to report the digit, ignoring the X when it was present. In the Verbal condition he named the digit, whereas in the Manual condition he held up the appropriate number of fingers (using the left hand for the numbers 1-5, and both hands for 6-9).In the Verbal condition WS was ...