Visual Form Agnosia Research Articles

A review of the impairments, preserved visual functions, and neuropathology in 21 patients with visual form agnosia – A unique defect with line drawings

We present a comprehensive review of the rare syndrome visual form agnosia (VFA). We begin by documenting its history, including the origins of the term, and the first case study labelled as VFA. The defining characteristics of the syndrome, as others have previously defined it, are then described. The impairments, preserved aspects of visual perception, and areas of brain damage in 21 patients who meet these defining characteristics are described in detail, including which tests were used to verify the presence or absence of key symptoms. From this, we note important similarities along with notable areas of divergence between patients. Damage to the occipital lobe (20/21), an inability to recognise line drawings (19/21), preserved colour vision (14/21), and visual field defects (16/21) were areas of consistency across most cases. We found it useful to distinguish between shape and form as distinct constructs when examining perceptual abilities in VFA patients. Our observations suggest that these patients often exhibit difficulties in processing simplified versions of form. Deficits in processing orientation and size were uncommon. Motion perception and visual imagery were not widely tested for despite being typically cited as defining features of the syndrome – although in the sample described, motion perception was never found to be a deficit. Moreover, problems with vision (e.g., poor visual acuity and the presence of hemianopias/scotomas in the visual fields) are more common than we would have thought and may also contribute to perceptual impairments in patients with VFA. We conclude that VFA is a perceptual disorder where the visual system has a reduced ability to synthesise lines together for the purposes of making sense of what images represent holistically.

The size-weight illusion in visual form agnosic patient DF

ABSTRACT The size-weight illusion is a perceptual illusion where smaller objects are judged as heavier than equally weighted larger objects. A previous informal report suggests that visual form agnosic patient DF does not experience the size-weight illusion when vision is the only available cue to object size. We tested this experimentally, comparing the magnitudes of DF’s visual, kinesthetic and visual-kinesthetic size-weight illusions to those of 28 similarly-aged controls. A modified t-test found that DF’s visual size-weight illusion was significantly smaller than that of controls (zcc = −1.7). A test of simple dissociation based on the Revised Standardized Difference Test found that the discrepancy between the magnitude of DF’s visual and kinesthetic size-weight illusions was not significantly different from that of controls (zdcc = −1.054), thereby failing to establish a dissociation between the visual and kinesthetic conditions. These results are consistent with previous suggestions that visual form agnosia, following ventral visual stream damage, is associated with an abnormally reduced size-weight illusion. The results, however, do not confirm that this reduction is specific to the use of visual size cues to predict object weight, rather than reflecting more general changes in the processing of object size cues or in the use of predictive strategies for lifting.

Still holding after all these years: An action-perception dissociation in patient DF

Patient DF, who has bilateral damage in the ventral visual stream, is perhaps the best known individual with visual form agnosia in the world, and has been the focus of scores of research papers over the past twenty-five years. The remarkable dissociation she exhibits between a profound deficit in perceptual report and a preserved ability to generate relatively normal visuomotor behaviour was early on a cornerstone in Goodale and Milner's (1992) two visual systems hypothesis. In recent years, however, there has been a greater emphasis on the damage that is evident in the posterior regions of her parietal cortex in both hemispheres. Deficits in several aspects of visuomotor control in the visual periphery have been demonstrated, leading some researchers to conclude that the double dissociation between vision-for-perception and vision-for-action in DF and patients with classic optic ataxia can no longer be assumed to be strong evidence for the division of labour between the dorsal and ventral streams of visual processing. In this short review, we argue that this is not the case. Indeed, after evaluating DF's performance and the location of her brain lesions, a clear picture of a double dissociation between DF and patients with optic ataxia is revealed. More than quarter of a century after the initial presentation of DF's unique case, she continues to provide compelling evidence for the idea that the ventral stream is critical for the perception of the shape and orientation of objects but not the visual control of skilled actions directed at those objects.

Rise and fall of the two visual systems theory

Among the many dissociations describing the visual system, the dual theory of two visual systems, respectively dedicated to perception and action, has yielded a lot of support. There are psychophysical, anatomical and neuropsychological arguments in favor of this theory. Several behavioral studies that used sensory and motor psychophysical parameters observed differences between perceptive and motor responses. The anatomical network of the visual system in the non-human primate was very readily organized according to two major pathways, dorsal and ventral. Neuropsychological studies, exploring optic ataxia and visual agnosia as characteristic deficits of these two pathways, led to the proposal of a functional double dissociation between visuomotor and visual perceptual functions. After a major wave of popularity that promoted great advances, particularly in knowledge of visuomotor functions, the guiding theory is now being reconsidered. Firstly, the idea of a double dissociation between optic ataxia and visual form agnosia, as cleanly separating visuomotor from visual perceptual functions, is no longer tenable; optic ataxia does not support a dissociation between perception and action and might be more accurately viewed as a negative image of action blindsight. Secondly, dissociations between perceptive and motor responses highlighted in the framework of this theory concern a very elementary level of action, even automatically guided action routines. Thirdly, the very rich interconnected network of the visual brain yields few arguments in favor of a strict perception/action dissociation. Overall, the dissociation between motor function and perceptive function explored by these behavioral and neuropsychological studies can help define an automatic level of action organization deficient in optic ataxia and preserved in action blindsight, and underlines the renewed need to consider the perception-action circle as a functional ensemble.

Impaired peripheral reaching and on-line corrections in patient DF: Optic ataxia with visual form agnosia

An influential model of vision suggests the presence of two visual streams within the brain: a dorsal occipito-parietal stream which mediates action and a ventral occipito-temporal stream which mediates perception. One of the cornerstones of this model is DF, a patient with visual form agnosia following bilateral ventral stream lesions. Despite her inability to identify and distinguish visual stimuli, DF can still use visual information to control her hand actions towards these stimuli. These observations have been widely interpreted as demonstrating a double dissociation from optic ataxia, a condition observed after bilateral dorsal stream damage in which patients are unable to act towards objects that they can recognize. In Experiment 1, we investigated how patient DF performed on the classical diagnostic task for optic ataxia, reaching in central and peripheral vision. We replicated recent findings that DF is remarkably inaccurate when reaching to peripheral targets, but not when reaching in free vision. In addition we present new evidence that her peripheral reaching errors follow the optic ataxia pattern increasing with target eccentricity and being biased towards fixation. In Experiments 2 and 3, for the first time we examined DF's on-line control of reaching using a double-step paradigm in fixation-controlled and free-vision versions of the task. DF was impaired when performing fast on-line corrections on all conditions tested, similarly to optic ataxia patients. Our findings question the long-standing assumption that DF's dorsal visual stream is functionally intact and that her on-line visuomotor control is spared. In contrast, in addition to visual form agnosia, DF also has visuomotor symptoms of optic ataxia which are most likely explained by bilateral damage to the superior parietal-occipital cortex (SPOC). We thus conclude that patient DF can no longer be considered as an appropriate single-case model for testing the neural basis of perception and action dissociations.

Reprint of: Object-based attentional facilitation and inhibition are neuropsychologically dissociated

Salient peripheral cues produce a transient shift of attention which is superseded by a sustained inhibitory effect. Cueing part of an object produces an inhibitory cueing effect (ICE) that spreads throughout the object. In dynamic scenes the ICE stays with objects as they move. We examined object-centred attentional facilitation and inhibition in a patient with visual form agnosia. There was no evidence of object-centred attentional facilitation. In contrast, object-centred ICE was observed in 3 out of 4 tasks. These inhibitory effects were strongest where cues to objecthood were highly salient. These data are evidence of a neuropsychological dissociation between the facilitatory and inhibitory effects of attentional cueing. From a theoretical perspective the findings suggest that ‘grouped arrays’ are sufficient for object-based inhibition, but insufficient to generate object-centred attentional facilitation.

Object-based attentional facilitation and inhibition are neuropsychologically dissociated

Salient peripheral cues produce a transient shift of attention which is superseded by a sustained inhibitory effect. Cueing part of an object produces an inhibitory cueing effect (ICE) that spreads throughout the object. In dynamic scenes the ICE stays with objects as they move. We examined object-centred attentional facilitation and inhibition in a patient with visual form agnosia. There was no evidence of object-centred attentional facilitation. In contrast, object-centred ICE was observed in 3 out of 4 tasks. These inhibitory effects were strongest where cues to objecthood were highly salient. These data are evidence of a neuropsychological dissociation between the facilitatory and inhibitory effects of attentional cueing. From a theoretical perspective the findings suggest that ‘grouped arrays’ are sufficient for object-based inhibition, but insufficient to generate object-centred attentional facilitation.

Reprint of: Visual processing of words in a patient with visual form agnosia: A behavioural and fMRI study

Patient D.F. has a profound and enduring visual form agnosia due to a carbon monoxide poisoning episode suffered in 1988. Her inability to distinguish simple geometric shapes or single alphanumeric characters can be attributed to a bilateral loss of cortical area LO, a loss that has been well established through structural and functional fMRI. Yet despite this severe perceptual deficit, D.F. is able to “guess” remarkably well the identity of whole words. This paradoxical finding, which we were able to replicate more than 20 years following her initial testing, raises the question as to whether D.F. has retained specialized brain circuitry for word recognition that is able to function to some degree without the benefit of inputs from area LO. We used fMRI to investigate this, and found regions in the left fusiform gyrus, left inferior frontal gyrus, and left middle temporal cortex that responded selectively to words. A group of healthy control subjects showed similar activations. The left fusiform activations appear to coincide with the area commonly named the visual word form area (VWFA) in studies of healthy individuals, and appear to be quite separate from the fusiform face area (FFA). We hypothesize that there is a route to this area that lies outside area LO, and which remains relatively unscathed in D.F.

Which visual functions depend on intermediate visual regions? Insights from a case of developmental visual form agnosia

A key question in visual neuroscience is the causal link between specific brain areas and perceptual functions; which regions are necessary for which visual functions? While the contribution of primary visual cortex and high-level visual regions to visual perception has been extensively investigated, the contribution of intermediate visual areas (e.g. V2/V3) to visual processes remains unclear. Here I review more than 20 visual functions (early, mid, and high-level) of LG, a developmental visual agnosic and prosopagnosic young adult, whose intermediate visual regions function in a significantly abnormal fashion as revealed through extensive fMRI and ERP investigations. While expectedly, some of LG's visual functions are significantly impaired, some of his visual functions are surprisingly normal (e.g. stereopsis, color, reading, biological motion). During the period of eight-year testing described here, LG trained on a perceptual learning paradigm that was successful in improving some but not all of his visual functions. Following LG's visual performance and taking into account additional findings in the field, I propose a framework for how different visual areas contribute to different visual functions, with an emphasis on intermediate visual regions. Thus, although rewiring and plasticity in the brain can occur during development to overcome and compensate for hindering developmental factors, LG's case seems to indicate that some visual functions are much less dependent on strict hierarchical flow than others, and can develop normally in spite of abnormal mid-level visual areas, thereby probably less dependent on intermediate visual regions.

Real-time vision, tactile cues, and visual form agnosia: removing haptic feedback from a "natural" grasping task induces pantomime-like grasps.

Investigators study the kinematics of grasping movements (prehension) under a variety of conditions to probe visuomotor function in normal and brain-damaged individuals. “Natural” prehensile acts are directed at the goal object and are executed using real-time vision. Typically, they also entail the use of tactile, proprioceptive, and kinesthetic sources of haptic feedback about the object (“haptics-based object information”) once contact with the object has been made. Natural and simulated (pantomimed) forms of prehension are thought to recruit different cortical structures: patient DF, who has visual form agnosia following bilateral damage to her temporal-occipital cortex, loses her ability to scale her grasp aperture to the size of targets (“grip scaling”) when her prehensile movements are based on a memory of a target previewed 2 s before the cue to respond or when her grasps are directed towards a visible virtual target but she is denied haptics-based information about the target. In the first of two experiments, we show that when DF performs real-time pantomimed grasps towards a 7.5 cm displaced imagined copy of a visible object such that her fingers make contact with the surface of the table, her grip scaling is in fact quite normal. This finding suggests that real-time vision and terminal tactile feedback are sufficient to preserve DF’s grip scaling slopes. In the second experiment, we examined an “unnatural” grasping task variant in which a tangible target (along with any proxy such as the surface of the table) is denied (i.e., no terminal tactile feedback). To do this, we used a mirror-apparatus to present virtual targets with and without a spatially coincident copy for the participants to grasp. We compared the grasp kinematics from trials with and without terminal tactile feedback to a real-time-pantomimed grasping task (one without tactile feedback) in which participants visualized a copy of the visible target as instructed in our laboratory in the past. Compared to natural grasps, removing tactile feedback increased RT, slowed the velocity of the reach, reduced in-flight grip aperture, increased the slopes relating grip aperture to target width, and reduced the final grip aperture (FGA). All of these effects were also observed in the real time-pantomime grasping task. These effects seem to be independent of those that arise from using the mirror in general as we also compared grasps directed towards virtual targets to those directed at real ones viewed directly through a pane of glass. These comparisons showed that the grasps directed at virtual targets increased grip aperture, slowed the velocity of the reach, and reduced the slopes relating grip aperture to the widths of the target. Thus, using the mirror has real consequences on grasp kinematics, reflecting the importance of task-relevant sources of online visual information for the programming and updating of natural prehensile movements. Taken together, these results provide compelling support for the view that removing terminal tactile feedback, even when the grasps are target-directed, induces a switch from real-time visual control towards one that depends more on visual perception and cognitive supervision. Providing terminal tactile feedback and real-time visual information can evidently keep the dorsal visuomotor system operating normally for prehensile acts.

Visual consciousness explained by its impairments.

The scientific study of the visual consciousness has been marked by significant recent achievements, resulting from an interaction between the exploration of cognition in both brain-damaged patients and healthy individuals. Several neuropsychological syndromes contain marked dissociations which permit the identification of principles related to the neurophysiology of consciousness. The generality of these principles can then be evaluated in healthy individuals using a combination of experimental psychology paradigms, and functional brain-imaging tools. In this article, I review major findings originating from the exploration of neuropsychological syndromes such as 'blindsight', visual form agnosia, optic ataxia, and neglect, and explain how they can be accounted for by a 'global workspace' model. These results constitute important constraints for neural theories of consciousness, and they are crucial to help clinicians handle patients affected with complex neurovisual disorders.

The Two Visual Systems Hypothesis: New Challenges and Insights from Visual form Agnosic Patient DF.

Patient DF, who developed visual form agnosia following carbon monoxide poisoning, is still able to use vision to adjust the configuration of her grasping hand to the geometry of a goal object. This striking dissociation between perception and action in DF provided a key piece of evidence for the formulation of Goodale and Milner’s Two Visual Systems Hypothesis (TVSH). According to the TVSH, the ventral stream plays a critical role in constructing our visual percepts, whereas the dorsal stream mediates the visual control of action, such as visually guided grasping. In this review, we discuss recent studies of DF that provide new insights into the functional organization of the dorsal and ventral streams. We confirm recent evidence that DF has dorsal as well as ventral brain damage – and that her dorsal-stream lesions and surrounding atrophy have increased in size since her first published brain scan. We argue that the damage to DF’s dorsal stream explains her deficits in directing actions at targets in the periphery. We then focus on DF’s ability to accurately adjust her in-flight hand aperture to changes in the width of goal objects (grip scaling) whose dimensions she cannot explicitly report. An examination of several studies of DF’s grip scaling under natural conditions reveals a modest though significant deficit. Importantly, however, she continues to show a robust dissociation between form vision for perception and form vision-for-action. We also review recent studies that explore the role of online visual feedback and terminal haptic feedback in the programming and control of her grasping. These studies make it clear that DF is no more reliant on visual or haptic feedback than are neurologically intact individuals. In short, we argue that her ability to grasp objects depends on visual feedforward processing carried out by visuomotor networks in her dorsal stream that function in the much the same way as they do in neurologically intact individuals.

Visual processing of words in a patient with visual form agnosia: A behavioural and fMRI study

Patient D.F. has a profound and enduring visual form agnosia due to a carbon monoxide poisoning episode suffered in 1988. Her inability to distinguish simple geometric shapes or single alphanumeric characters can be attributed to a bilateral loss of cortical area LO, a loss that has been well established through structural and functional fMRI. Yet despite this severe perceptual deficit, D.F. is able to “guess” remarkably well the identity of whole words. This paradoxical finding, which we were able to replicate more than 20 years following her initial testing, raises the question as to whether D.F. has retained specialized brain circuitry for word recognition that is able to function to some degree without the benefit of inputs from area LO. We used fMRI to investigate this, and found regions in the left fusiform gyrus, left inferior frontal gyrus, and left middle temporal cortex that responded selectively to words. A group of healthy control subjects showed similar activations. The left fusiform activations appear to coincide with the area commonly named the visual word form area (VWFA) in studies of healthy individuals, and appear to be quite separate from the fusiform face area (FFA). We hypothesize that there is a route to this area that lies outside area LO, and which remains relatively unscathed in D.F.

Patient DF’s visual brain in action: Visual feedforward control in visual form agnosia

Patient DF, who developed visual form agnosia following ventral-stream damage, is unable to discriminate the width of objects, performing at chance, for example, when asked to open her thumb and forefinger a matching amount. Remarkably, however, DF adjusts her hand aperture to accommodate the width of objects when reaching out to pick them up (grip scaling). While this spared ability to grasp objects is presumed to be mediated by visuomotor modules in her relatively intact dorsal stream, it is possible that it may rely abnormally on online visual or haptic feedback. We report here that DF’s grip scaling remained intact when her vision was completely suppressed during grasp movements, and it still dissociated sharply from her poor perceptual estimates of target size. We then tested whether providing trial-by-trial haptic feedback after making such perceptual estimates might improve DF’s performance, but found that they remained significantly impaired. In a final experiment, we re-examined whether DF’s grip scaling depends on receiving veridical haptic feedback during grasping. In one condition, the haptic feedback was identical to the visual targets. In a second condition, the haptic feedback was of a constant intermediate width while the visual target varied trial by trial. Despite this incongruent feedback, DF still scaled her grip aperture to the visual widths of the target blocks, showing only normal adaptation to the false haptically-experienced width. Taken together, these results strengthen the view that DF’s spared grasping relies on a normal mode of dorsal-stream functioning, based chiefly on visual feedforward processing.

Real-world size improves object recognition in visual form agnosia

Real-world size improves object recognition in visual form agnosia

Line-bisectioning and obstacle avoidance: Evidence for separate strategies

Previous studies have frequently applied a combination of line-bisection tasks (in which participants indicate the middle of a line) and obstacle avoidance tasks (in which participants move their hand between two obstacles) with the aim of revealing perception–action dissociations in certain neurological disorders, such as visual form agnosia and optic ataxia. However, valid conclusions about the underlying processing pathways can only be drawn if participants apply the same strategy in both tasks (i.e. finding the middle between the obstacles). Yet, this assumption has never been tested directly. In this experiment, we investigated whether participants perform obstacle avoidance and line-bisectioning using similar strategies by manipulating the position of the obstacles and the start position of the hand relative to the obstacles. Our results indicate that the lateral hand position during obstacle avoidance does not only vary as a function of obstacle location but also strongly depends on the start position. Moreover, participants showed increased sensitivity to obstacle shifts occurring closer to the hand's start position. In contrast, during line-bisectioning the sensitivity to obstacles shifts was unaffected by the hand's start position. The findings suggest that during obstacle-avoidance the need to keep a safe distance from the obstacles is balanced with the requirement to minimise energetic demands. In contrast, the main intention during line-bisectioning is to move to the perceived midpoint as accurately as possible. The fact that very different constraints underlie trajectory planning in both tasks implies that caution has to be taken when interpreting differences in performance levels.

Delayed action does not always require the ventral stream: A study on a patient with visual form agnosia

It has been suggested that while movements directed at visible targets are processed within the dorsal stream, movements executed after delay rely on the visual representations of the ventral stream (Milner & Goodale, 2006). This interpretation is supported by the observation that a patient with ventral stream damage (D.F.) has trouble performing accurate movements after a delay, but performs normally when the target is visible during movement programming. We tested D.F.'s visuomotor performance in a letter-posting task whilst varying the amount of visual feedback available. Additionally, we also varied whether D.F. received tactile feedback at the end of each trial (posting through a letter box vs posting on a screen) and whether environmental cues were available during the delay period (removing the target only vs suppressing vision completely with shutter glasses). We found that in the absence of environmental cues patient D.F. was unaffected by the introduction of delay and performed as accurately as healthy controls. However, when environmental cues and vision of the moving hand were available during and after the delay period, D.F.'s visuomotor performance was impaired. Thus, while healthy controls benefit from the availability of environmental landmarks and/or visual feedback of the moving hand, such cues seem less beneficial to D.F. Taken together our findings suggest that ventral stream damage does not always impact the ability to make delayed movements but compromises the ability to use environmental landmarks and visual feedback efficiently.

When apperceptive agnosia is explained by a deficit of primary visual processing

Visual agnosia is a deficit in shape perception, affecting figure, object, face and letter recognition. Agnosia is usually attributed to lesions to high-order modules of the visual system, which combine visual cues to represent the shape of objects. However, most of previously reported agnosia cases presented visual field (VF) defects and poor primary visual processing. The present case-study aims to verify whether form agnosia could be explained by a deficit in basic visual functions, rather that by a deficit in high-order shape recognition. Patient SDV suffered a bilateral lesion of the occipital cortex due to anoxia. When tested, he could navigate, interact with others, and was autonomous in daily life activities. However, he could not recognize objects from drawings and figures, read or recognize familiar faces. He was able to recognize objects by touch and people from their voice. Assessments of visual functions showed blindness at the centre of the VF, up to almost 5°, bilaterally, with better stimulus detection in the periphery. Colour and motion perception was preserved. Psychophysical experiments showed that SDV's visual recognition deficits were not explained by poor spatial acuity or by the crowding effect. Rather a severe deficit in line orientation processing might be a key mechanism explaining SDV's agnosia. Line orientation processing is a basic function of primary visual cortex neurons, necessary for detecting “edges” of visual stimuli to build up a “primal sketch” for object recognition. We propose, therefore, that some forms of visual agnosia may be explained by deficits in basic visual functions due to widespread lesions of the primary visual areas, affecting primary levels of visual processing.

DF's visual brain in action: The role of tactile cues

Patient DF, an extensively-tested woman with visual form agnosia from ventral-stream damage, is able to scale her grip aperture to match a goal object's geometry when reaching out to pick it up, despite being unable to explicitly distinguish amongst objects on the basis of their different geometries. Using evidence from a range of sources, including functional MRI, we have proposed that she does this through a functionally intact visuomotor system housed within the dorsal stream of the posterior parietal lobe. More recently, however, Schenk (2012a). The Journal of Neuroscience, 32(6), 2013–2017; Schenk (2012b). Trends in Cognitive Sciences, 16(5), 258–259. has argued that DF performs well in visually guided grasping, not through spared and functioning visuomotor networks in the dorsal stream, but because haptic feedback about the locations of the edges of the target is available to calibrate her grasps in such tasks, whereas it is not available in standard visual perceptual tasks. We have tested this 'calibration hypothesis' directly, by presenting DF with a grasping task in which the visible width of a target varied from trial to trial while its actual width remained the same. According to the calibration hypothesis, because haptic feedback was completely uninformative, DF should be unable to calibrate her grip aperture in this task. Contrary to this prediction, we found that DF continued to scale her grip aperture to the visual width of the targets and did so well within the range of healthy controls. We also found that DF's inability to distinguish shapes perceptually is not improved by providing haptic feedback. These findings strengthen the notion that DF’s spared visuomotor abilities are driven largely by visual feedforward processing of the geometric properties of the target. Crucially, these findings also indicate that simple tactile contact with an object is needed for the visuomotor dorsal stream to be engaged, and accordingly enables DF to execute visually guided grasping successfully. This need for actions to have a tangible endpoint provides an important new modification of the Two Visual Systems theory.

Structural and Functional Changes across the Visual Cortex of a Patient with Visual Form Agnosia

Loss of shape recognition in visual-form agnosia occurs without equivalent losses in the use of vision to guide actions, providing support for the hypothesis of two visual systems (for "perception" and "action"). The human individual DF received a toxic exposure to carbon monoxide some years ago, which resulted in a persisting visual-form agnosia that has been extensively characterized at the behavioral level. We conducted a detailed high-resolution MRI study of DF's cortex, combining structural and functional measurements. We present the first accurate quantification of the changes in thickness across DF's occipital cortex, finding the most substantial loss in the lateral occipital cortex (LOC). There are reduced white matter connections between LOC and other areas. Functional measures show pockets of activity that survive within structurally damaged areas. The topographic mapping of visual areas showed that ordered retinotopic maps were evident for DF in the ventral portions of visual cortical areas V1, V2, V3, and hV4. Although V1 shows evidence of topographic order in its dorsal portion, such maps could not be found in the dorsal parts of V2 and V3. We conclude that it is not possible to understand fully the deficits in object perception in visual-form agnosia without the exploitation of both structural and functional measurements. Our results also highlight for DF the cortical routes through which visual information is able to pass to support her well-documented abilities to use visual information to guide actions.