Prosopagnosia can be associated with damage confined to the right hemisphere--an MRI and PET study and a review of the literature

The early position that prosopagnosia is predominantly associated with right hemisphere (RH) injury was challenged by the finding that in practically all cases that come to autopsy pathological data point to bilateral damage. Yet the rejection of the RH hypothesis may have been too hasty. We report three prosopagnosic patients in whom MRI and CT documented a lesion confined to the right occipito-temporal areas and PET confirmed that hypometabolism involved the RH only. A review of the literature brought out 27 cases with neuroimaging evidence that prosopagnosia was associated with RH damage plus four cases with surgical evidence. It remains, however, that the inability to recognize familiar faces is a rare disorder, not manifested by the majority of patients with right temporo-occipital injury. We submit that right-handers differ in the degree of their RH specialization in processing faces and that in only a minority of them is it so marked that it cannot be compensated for by the healthy left hemisphere.