Acquired mirror writing and reading: Evidence for reflected graphemic representations

Mirror writing occurs when individual letters and whole word strings are produced in reverse direction. By analogy, mirror reading refers to the preference to read mirror reversed over normally written words. These phenomena appear rarely after brain damage and offer insight into the nervous system's organization of visual-spatial and visual-motor representations. We present the case of a 51-year-old patient with persistent mirror writing and reading following traumatic brain injury. She preferred to write in the mirror direction with either hand. She drew asymmetric pictures with the same directional bias as normal right-handed subjects, and she did not exhibit left-right confusion regarding other pictures. By contrast, on picture-word matching and lexical decision tasks, she was faster and more accurate with mirrored than normally written words. This pattern of performance suggests that her behavior was not accounted for by reflected motor programs, or by the mirroring of visual-spatial representations in general. Rather, we suggest that her behavior was produced by privileged access to mirrored graphemes. Furthermore, because she seemed better able to read irregular words in mirrored than in normal formats, we suggest that mirrored representations may exist at the whole word level and not simply at the letter level.