Apperceptive Prosopagnosia Secondary to an Ischemic Infarct of the Lingual Gyrus: A Case Report and an Update on the Neuroanatomy, Neurophysiology, and Phenomenology of Prosopagnosia

Phenomenology is the philosophical study of experience and its core feature of sentience, the very ability to be conscious of a sensation and how we perceive it. Nowhere is this idea more vivid, as in the phenomenon of vision and the ability to form and sense a visual percept. The clinical entity of prosopagnosia, the ability to sense but not recognize a face, strikes at the heart of this phenomenon. We describe a classic case of selective apperceptive prosopagnosia due to an ischemic infarct of the left occipital lobe with extension to the lingual gyrus. It is well-established that acquired prosopagnosia usually involves the right more than the left occipital cortex, with localization of lesions bilaterally more than unilaterally. The ischemic infarcts strategically involve the fusiform gyrus, inferior occipital gyrus, the fundus of the posterior temporal sulcus, parahippocampal gyrus, and, rarely, lingual gyrus, which is almost always not a solitary finding. We seize upon this opportunity to explore the concept of visual prosopagnosia and outline the latest ideas on the neuroanatomical localization, neurophysiology, and classification of this intriguing phenomenon.