Cortical activation in hemianopia after stroke.
ABSTRACT Changes in neuronal activity of the visual cortex have been described in patients with hemianopia. The anatomical areas that are involved in neuroplastic changes have not been studied in a larger group of stroke patients with a homogenous structural pathology of the visual cortex. Brain activation was measured in 13 patients with a single ischemic lesion of the striate cortex and partially recovered hemianopia and in 13 age-matched control subjects using blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI). Differences in activation between rest and visual hemifield stimulation were assessed with statistical parametric mapping using group and multi-group studies. In normal subjects, the most significant activation was found in the contralateral primary visual cortex (area 17) and bilaterally in the extrastriate cortex (areas 18 and 19). In patients, these areas were also activated when the intact hemifield was stimulated. During stimulation of the hemianopic side, bilateral activation was seen within the extrastriate cortex, stronger in the ipsilateral (contralesional) hemisphere. Stimulation of the hemianopic visual field is associated with ipsilateral activation of the extrastriate visual cortex. This pattern of activation suggests extensive neuronal plasticity within the visual cortex after postgeniculate ischemic lesions and may have implications for therapeutic interventions.
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ABSTRACT: It remains unclear to what extent retinotopic maps can undergo large-scale plasticity following damage to human visual cortex. The literature has predominately focused on retinotopic changes in patients with retinal pathologies or congenital brain malformations. Yet, damage to the adult visual cortex itself is common in cases such as stroke, tumor, or trauma. To address this issue, we used a unique database of fMRI vision maps in patients with adult-onset (n = 25) and congenital (n = 2) pathology of the visual cortex. We identified atypical retinotopic organization in three patients (two with adult-onset, and one with congenital pathology) consisting of an expanded ipsilateral field representation that was on average 3.2 times greater than healthy controls. The expanded representations were located at the vertical meridian borders between visual areas such as V1/V2. Additionally, two of the three patients had apparently an ectopic (topographically inconsistent) representation of the ipsilateral field within lateral occipital cortex that is normally associated with visual areas V3/V3A (and possibly other areas). Both adult-onset cases had direct damage to early visual cortex itself (rather than to the afferent drive only), resulting in a mostly nonfunctional hemisphere. The congenital case had severe cortical malformation of the visual cortex and was acallosal. Our results are consistent with a competitive model in which unilateral damage to visual cortex or disruption of the transcallosal connections removes interhemispheric suppression from retino-geniculate afferents in intact visual cortex that represent the vertical meridian and ipsilateral visual field.Journal of Neuroscience 08/2013; 33(32):13010-24. · 6.91 Impact Factor
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ABSTRACT: Homonymous visual field defects (HVFDs) are a common consequence of posterior brain injury. Most patients do not recover spontaneously and require rehabiliation. To determine whether a certain intervention may help an individual patient, it is necessary to predict the patient's level of functioning and the effect of specific training. We provide an overview of both the existing literature on HVFDs in terms of the International Classification of Functioning, Disability, and Health (ICF) components and the variables predicting the functioning of HVFD patients or the effect of treatment. We systematically analyzed 221 publications on HVFD. All variables included in these articles were classified according to the ICF, as developed by the World Health Organization, and checked for their predictive value. We found that ICF helps to clarify the scope of the existing literature and provides a framework for designing future studies, which should consider including more outcome measures related to Activities and Participation. Although several factors have been described that predict HVFD patients' level of functioning or the effects of training, additional research is necessary to identify more.Survey of Ophthalmology 10/2013; · 2.86 Impact Factor
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ABSTRACT: Damage along the visual pathway results in a visual field defect (scotoma), which retinotopically corresponds to the damaged neural tissue. Other parts of the visual field, processed by the uninjured tissue, are considered to be intact. However, perceptual deficits have been observed in the "intact" visual field, but these functional impairments are poorly understood. We now studied temporal processing deficits in the intact visual field of patients with either pre- or post-chiasmatic lesions to better understand the functional consequences of partial blindness. Patients with pre- (n = 53) or post- chiasmatic lesions (n = 98) were tested with high resolution perimetry - a method used to map visual fields with supra-threshold light stimuli. Reaction time of detections in the intact visual field was then analyzed as an indicator of processing speed and correlated with features of the visual field defect. Patients from both groups exhibited processing speed deficits in their presumably "intact" field as indicated by comparison to a normative sample. Further, in both groups processing speed was found to be a function of two factors. Firstly, a spatially restricted (retinotopic) influence of the scotoma was seen in longer reaction times when stimuli were presented in intact field sectors close to the defect. Secondly, patients with larger scotomata had on average longer reaction times in their intact field indicating a more general (non-retinotopic) influence of the scotoma. Processing speed deficits in the "intact" visual field of patients with visual system damage demonstrate that visual system lesions have more widespread consequences on perception than previously thought. Because dysfunctions of the seeing field are expected to contribute to subjective vision, including visual tests of the presumed "intact" field may help to better understand vision loss and to improve methods of vision restoration and rehabilitation.PLoS ONE 01/2013; 8(5):e63700. · 3.53 Impact Factor