Letter dyslexia in a letter-by-letter reader

We describe a letter-by-letter patient who produced misreading errors in both letters in isolation and in words. All errors were visual in nature. We hypothesized an access deficit to the abstract visual representation of letters that prevents letter identification. This deficit could account for the patient's letter-by-letter behavior, since each letter constituted a potential identification problem. An access deficit, moreover, could also explain the patient's letter visual errors. In access processing, in fact, the letters sharing common structural features in their abstract representations were the ones more frequently mismatched.