Prosopagnosia is a type of visual agnosia distinguished by an inability to recognize familiar faces not better accounted for by general deficits of vision, object recognition, or memory. An apperceptive prosopagnosia variant is typically associated with injury to the right fusiform gyrus and is correlated with the inability to differentiate specific facial structures. This disorder can be associated with loss of color vision, visual field deficits, visual hemi-neglect, and simultagnosia.

CASE REPORT:

A 66 year-old male with Parkinson’s disease and prior ischemic infarcts presented with a lack of color vision and inability to recognize faces on the television. His exam was significant for achromotopsia without a visual field deficit, MOCA of 21/30, and evidence of Parkinson’s disease. He was unable to recognize familiar faces (past presidents, family, or movie stars), but was able to identify them by voice recordings. When presented with silhouettes of cartoon heads (Mickey Mouse, Donald duck, etc.) the patient was able to accurately name every character. He was found to have an acute infract in the right PCA distribution of the occipital-temporal lobe, including the fusiform gyrus. He underwent neuropsychiatric rehabilitation that focused on the ability to recognize people by other means, including by voice and clothing. At three months, patient did not recover visual recognition of people.

Right-sided fusiform gyrus infarctions are classically associated with a deficit of prosopagnosia, the inability to recognize familiar faces. Our patient incongruously recognized cartoon faces vs. human ones. The preservation of only caricatures in prosopagnosia has not been previously reported. This finding, if observed in others, could provide further clarification to the facial recognition pathway as it is currently understood.