Abstract This study was designed to identify the neural network supporting the semantic processing of visual words in a patient with large-scale damage to left-hemisphere (LH) language structures. Patient GP, and a control subject, RT, performed semantic and orthographic tasks while brain-activation patterns were recorded using functional magnetic resonance imaging. In RT, the semantic-orthographic comparison activated LH perisylvian and extrasylvian temporal regions comparable to the network of areas activated by non-brain-damaged subjects in other neuroimaging studies of semantic discrimination. In GP, the same comparison activated homologous right-hemisphere regions, demonstrating the ability of the right hemisphere to subserve visual lexicosemantic processes. The results are discussed within the context of the normal right hemisphere's capacity for semantic processing of visual words. Examining results from functional neuroimaging studies on recovery in the context of innate hemispheric abilities may enable reconciliation of disparate claims about mechanisms supporting recovery from aphasia.