Neuropsychological and activation studies on the neural correlates of abstract and concrete words have produced contrasting results. The present study explores the anatomical substrates of abstract/concrete words in 22 brain-damaged patients with a single vascular lesion either in the right or left hemisphere. One hundred and twenty (60 concrete and 60 abstract) noun triplets were used for a semantic similarity judgment task. We found a significant interaction in word type × group since left temporal brain-damaged patients performed significantly better with concrete than abstract words. Lesion mapping of patients with predominant temporal damage showed that the left superior and middle temporal gyri and the insula were the areas of major overlapping, while the anterior portion of the left temporal lobe was generally spared. Errors on abstract words mainly concerned (although at a non-significant level) semantically associate targets, while in the case of concrete words, coordinate targets were significantly more impaired than associate ones. Our results suggest that the left superior and middle temporal gyri and the insula are crucial regions in processing abstract words. They also confirm the hypothesis of a semantic similarity vs. associative organization of concrete and abstract concepts.