Cerebral pathways for calculation: Double dissociation between rote verbal and quantitative knowledge of arithmetic

We describe two acalculic patients, one with a left subcortical lesion and the other with a right inferior parietal lesion and Gerstmann's syndrome. Both suffered from ''pure anarithmetia'': they could read arabic numerals and write them to dictation, but experienced a pronounced calculation deficit. On closer analysis, however, distinct deficits were found. The subcortical case suffered from a selective deficit of rote verbal knowledge, including but not limited to arithmetic tables, while her semantic knowledge of numerical quantities was intact. Conversely the inferior parietal case suffered from a category-specific impairment of quantitative numerical knowledge, particularly salient in subtraction and number bissection tasks, with preserved knowledge of rote arithmetic facts. This double dissociation suggests that numerical knowledge is processed in different formats within distinct cerebral pathways. We suggest that a left subcortical network contributes to the storage and retrieval of rote verbal arithmetic facts, while a bilateral inferior parietal network is dedicated to the mental manipulation of numerical quantities.