Can’t Recognize Faces After Stroke? You May Have Prosopagnosia

If you or a loved one can’t recognize faces after stroke, it could indicate a secondary effect called prosopagnosia — also known as “facial blindness.”

This article will discuss the causes and treatment for prosopagnosia after stroke.

Why Can’t I Recognize Faces After Stroke?

Prosopagnosia is a neurological disorder that, most notably, impairs an individual’s ability to recognize faces. It can sometimes impair a person’s ability to recognize facial social cues as well. In some rare cases, people with the condition report difficulty recognizing other things like places or objects, however this would typically be classified as a different type of agnosia altogether.

A major cause of prosopagnosia is stroke. A stroke occurs where the supply of blood in the brain is compromised. When this happens, areas of the brain are deprived of oxygen-rich blood and vulnerable to damage, which leads to secondary effects — such as prosopagnosia.

Each area of the brain controls different functions, such as logic and reasoning. Often, it helps to look at the area of the brain affected by stroke to roughly determine which secondary effects may occur.

One clinical sample found that half of those who survived a right hemisphere stroke had prosopagnosia.

Another study looked at 44 stroke survivors with prosopagnosia and found that the majority of them had damage in the right fusiform gyrus. This area of the brain, part of the temporal lobe and occipital lobe, is thought to play a major role in facial recognition. However, not every individual with a stroke in the temporal or occipital lobe will experience prosopagnosia, because every brain is different and every stroke is different.

Even among individuals with prosopagnosia, differences in causes and symptoms of the condition can be seen.

Symptoms of Prosopagnosia After Stroke

The symptoms of prosopagnosia manifest differently in everyone. However, one constant remains the same: prosopagnosia involves difficulty with facial recognition.

In severe cases, a survivor with prosopagnosia can’t recognize familiar faces after stroke – even the faces of close friends and family. Other individuals may have trouble distinguishing between two unknown faces, or even between a face and an object. In rare cases, the struggle may be with recognizing certain facial cues.

It’s important to work with a neurologist to get an accurate diagnosis. Otherwise, the individual runs the risk of being deeply misunderstood.

For example, a survivor may not realize that they can’t recognize facial cues. If someone looks sad, the person with prosopagnosia may not realize it and may say something insensitive.

In this example, the person with prosopagnosia could be deeply misunderstood as apathetic or self-centered.

This is why it’s important to work with a neurologist for an accurate diagnosis.

Treatment for Prosopagnosia

Treatment for most secondary effects of a stroke revolve around neuroplasticity.

Neuroplasticity is the brain’s natural ability to rewire itself. It’s the basis for both learning in the intact brain and relearning in the damaged brain that occurs through physical rehabilitation.

When a stroke damages an area of the brain, neuroplasticity allows healthy areas of the brain to take on the function.

Therefore, if facial recognition was impaired due to damage to the right fusiform gyrus area (or other area that contributes to facial recognition), then neuroplasticity can encourage healthy areas to take on the function. But how?

Neuroplasticity is activated by massed practice. When a skill is practiced with high intensity, the brain strengthens the neural pathways for that function.

It can be argued that practicing facial recognition can help a person with prosopagnosia get better at this task. Some cognitive training apps, such as the CT Speech & Cognitive Therapy app, contain activities that involve matching faces. Until more therapies are available for prosopagnosia, individuals can get creative with how they practice facial recognition.

Alexander Cohen, MD, Ph.D. – who led the study on 44 stroke survivors with prosopagnosia – mentioned that “novel therapies like transcranial magnetic stimulation or functional-MRI-based neurofeedback” can be explored.

Using Compensation Strategies in the Meantime

In the meantime, it can be helpful for individuals with prosopagnosia to use compensation strategies to cope with the condition.

For instance, some individuals have luck by using the clothing a person is wearing to identify them. Others get more creative by using voice tone, body shape, type of hair, or gait to help identify other people.

Ultimately, compensation strategies offer short cuts that help survivors cope with their condition. It’s not a perfect solution, but it offers a way to improve your quality of life as you pursue recovery.

Coping with Prosopagnosia After Stroke

If you or a loved one struggle with recognizing faces after a stroke, work with a neurologist for a formal diagnosis. In the meantime, try to develop some compensation strategies that can help you identify close friends and family without needing to rely on faces.

And if you’re feeling ambitious, consider doing cognitive training activities that help you practice recognizing faces. While this is not proven to work, the brain has proven to be highly adaptive. You’ll never know what’s possible until you try.

We wish you the best of luck on your unique journey!