The visual word form area: spatial and temporal characterization of an initial stage of reading in normal subjects and posterior split-brain patients.

A standard model of word reading postulates that visual information is initially processed by occipitotemporal areas contralateral to the stimulated hemifield, from whence it is subsequently transferred to the visual word form (VWF) system, a left inferior temporal region specifically devoted to the processing of letter strings. For stimuli displayed in the left visual field, this transfer proceeds from the right to the left hemisphere through the posterior portion of the corpus callosum. In order to characterize the spatial and temporal organization of these processes, reading tasks with split-field presentation were performed by five control subjects and by two patients suffering from left hemialexia following posterior callosal lesions. The subjects' responses were studied using behavioural measures and functional brain imaging techniques, providing both high spatial resolution (functional MRI, fMRI) and high temporal resolution (high-density event-related potentials, ERPs). Early visual processing was revealed as activations contralateral to stimulation, located by fMRI in the inferior occipitotemporal region and presumably coincident with area V4. A negative wave occurring 150-160 ms post-stimulus, also strictly contralateral to stimulation, was recorded over posterior electrodes. In contrast with these hemifield-dependent effects, the VWF system was revealed as a strictly left-hemispheric activation which, in control subjects, was identical for stimuli presented in the left or in the right hemifield and was located in the middle portion of the left fusiform gyrus. The electrical signature of the VWF system consisted of a unilateral sharp negativity, recorded 180-200 ms post-stimulus over left inferior temporal electrodes. In callosal patients, due to the inability of visual information to pass across the posterior part of the corpus callosum, the VWF system was activated only by stimuli presented in the right visual field. Similarly, a significant influence of the word/non-word status on ERPs recorded over the left hemisphere was discernible for either hemifield in controls, while it affected only right-hemifield stimuli in callosal patients. These findings provide direct support for the main components of the classical model of reading and help specify their timing and cerebral substrates.