It is usually assumed that written word is dependent upon spoken word and in aphasia and similar disorders, speech and written components are equally affected. But there are many cases where it can be seen that its not always the same and speech and written components are many a times differently affected. Obligatory phonological mediation hypothesis and orthographic autonomy hypothesis represent these conflicting perspectives. According to the obligatory phonological mediation hypothesis, written language necessarily involves phonological mediation and is entirely dependent upon spoken language. The semantic system activates the phonological form of a word, which then activates the corresponding orthographic representation. In contrast, the orthographic autonomy hypothesis posits that the lexical orthographic representations of words can be accessed without any necessary phonological mediation and can be directly activated from the semantic system. The obligatory phonological mediation and orthographic autonomy hypotheses predicts differently the possible effects of brain damage on written naming. On the basis of the phonological mediation hypothesis, an impairment at the level of the phonological lexicon should always affect both spoken and written naming and in double naming tasks, the word selected for a written response should always correspond to the one selected for a spoken output. But on the basis of orthographic autonomy hypothesis, the orthographic lexicon can be accessed directly from semantics therefore it should be possible to observe cases with impaired spoken naming due to damage to the phonological lexicon with no written naming deficit and double naming tasks in spoken and written modalities may give rise to lexically inconsistent responses. In support of this view, a number of cases showing dissociation in phonological lexical forms and orthographic forms including spared knowledge of orthographic forms despite an impairment affecting phonological lexical forms with intact articulatory abilities or lexically inconsistent responses in consecutive double naming tasks in different modalities of writing and speech have been reported across a number of languages. Here, different case studies showing dissociation in phonological lexical forms (spoken speech) and orthographic forms (writing) are reviewed providing evidence that access to the orthographic form of words can occur independently.