We evaluated the hypothesis that Brodmann's area (BA) 37 within left occipitotemporal cortex has at least two important functions in lexical processing. One role is the computation of case-, font-, location-, and orientation-independent grapheme descriptions for written word recognition and production (reading and spelling). This role may depend on the medial part of BA 37, in left midfusiform gyrus. The second role is in accessing modality-independent lexical representations for output, for naming and for reading and spelling of irregular or exception words. This role may depend on the lateral part of BA 37 in inferior temporal cortex. We tested these hypotheses in 234 participants with acute left hemisphere ischaemic stroke who underwent magnetic resonance imaging (MRI) and language testing within 48 hours of onset of stroke symptoms.