A rose is a rose or a nose: A deficit in initial letter identification

We describe the letter and word identification performance of a patient with a posterior left-hemisphere lesion, a right homonymous hemianopia, and unimpaired performance on tests for visuo-spatial neglect. His frequent errors in single word reading were almost all of the variety suggested by the title, i.e. rose → “nose”. The likelihood of his correctly identifying a word was significantly affected by lexical constraints on the initial letter, with words like rose (_ose can be many different words) yielding lower performance than words with a unique first letter (_oap can only be soap). The patient also made errors in identifying single isolated letters, and was particularly likely to misidentify the initial character in random strings of letters. By striking contrast, he identified letters in positions 2-N of words or strings with good accuracy. A variety of reading tasks and stimulus types were employed in an attempt to characterise and understand this pattern of performance.