Pattern electroretinograms after cerebral hemispherectomy

Transneuronal retrograde degeneration of retinal ganglion cells and optic tract in hemianopic monkeys and humans

Transneuronal retrograde degeneration of retinal ganglion cells after removal of primary visual cortex (area V1) is well established by quantitative neurohistological analysis of the ganglion cell layer in monkeys, but remains controversial in human patients. Therefore, we first histologically examined retinal degeneration in sectioned archived retinae of 26 macaque monkeys with unilateral V1 ablation and post-surgical survival times ranging from 3 months to 14.3 years. In addition, the cross-sectional area of the optic tract was measured in archived coronal histological sections of the brain of every hemianopic monkey and in sections from 10 control monkeys with non-visual bilateral cortical lesions. The ratios of nasal and temporal retinal ganglion cell counts in the contralesional eye and ipsi/contralateral optic tract areas were calculated and compared. They show that the decline was initially more pronounced for the optic tract, slackened after 3 years post-lesion and was steeper for the ganglion cells thereafter. Nevertheless, both measures were highly correlated. Second, we calculated ratios from structural magnetic resonance images to see whether the optic tracts of four human hemianopes would show similar evidence of transneuronal degeneration of their ipsilesional optic tract. The results were consistent with extensive and time-dependent degeneration of the retinal ganglion cell layer. The measures of the optic tracts provide evidence for comparable transneuronal retinal ganglion cell degeneration in both primate species and show that structural magnetic resonance image can both reveal and assess it.

Illusory motion perception in blindsight

Motion detection is typically spared in blindsight, which results from damage to the striate cortex (area V1) of the brain that is sufficient to eliminate conscious visual awareness and severely reduce sensitivity to luminance contrast, especially for high spatial and low temporal frequencies. Here we show that the discrimination of motion direction within cortically blind fields is not attributable to feature tracking (the detection of changes in position or shape), but is due instead to the detection of first-order motion energy (spatiotemporal changes in luminance). The key to this finding was a version of the line motion illusion entailing reverse-phi motion in which opposing motion directions are simultaneously cued by motion energy and changes in stimulus shape. In forced-choice tests, a blindsighted test subject selected the direction cued by shape change when the stimulus was presented in his intact field, but reliably selected the direction cued by motion energy when the same stimulus was presented in his blind field, where relevant position information was either inaccessible or invalid. Motion energy has been characterized as objectless, so reliance on motion energy detection is consistent with impaired access to shape information in blindsight. The dissociation of motion direction by visual field (cortically blind vs. intact) provides evidence that two pathways from the retina to MT/V5 (the cortical area specialized for motion perception) are functionally distinct: the retinogeniculate pathway through V1 is specialized for feature-based motion perception, whereas the retinocollicular pathway, which bypasses V1, is specialized for detecting motion energy.

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Purpose of the study was to compare Rarebit Perimetry (RP) with Standard Automatic Perimetry (SAP) in patients with ischemic retrochiasmal lesions. Seventeen patients with homonymous hemianopia underwent SAP and RP. Correlation between the two techniques was evaluated, congruent defects were quantified in the spared hemifield and residual vision areas were investigated in the blind hemifield. A strong correlation was found between SAP and RP. In the spared hemifield, RP detected congruent defects in a higher percentage of cases. Residual detection function has been found at RP in 69,2 % of perimetrically blind visual field quadrants as assessed by SAP. In conclusion, RP appears to be useful to assess visual function in hemianopic patients. As compared to SAP, it seems able to detect small congruent defects in a higher percentage of cases. Finally, a certain residual function seems to be present at RP in the blind regions of the visual field, however, for this finding further demonstrations are required.

Diffusion tensor imaging of brain plasticity after occipital lobectomy

Reorganization involving residual visual pathways with unilateral damage to the primary visual cortex was previously described. Using diffusion tensor imaging, we measured water diffusion-related changes in the optic radiation contralateral to occipital lobe ablation in children with intractable epilepsy. We studied 10 children who had undergone a resection of the unilateral occipital cortex and 13 control subjects. Diffusion tensor imaging was acquired using a 1.5 Tesla magnetic resonance scanner. Fiber bundles representing optic radiation were tracked. Diffusion parameters included mean fractional anisotropy, apparent diffusion coefficient, and diffusion parallel and perpendicular to the fiber tract. In the surgical group, fractional anisotropy values of optic radiation contralateral to the side of resection exhibited a significant positive partial correlation (r = 0.752, P = 0.019) with duration of time between surgery and diffusion tensor imaging acquisition, after controlling for age. The apparent diffusion coefficient and parallel diffusivity were higher in the surgical versus the control group, but did not differ among patients. After unilateral resection of the occipital lobe, the contralateral optic radiation undergoes significant changes in anisotropy. Such structural white-matter changes may represent an adaptive response because of unilateral occipital ablation, and may account for plasticity changes observed in functional magnetic resonance imaging.

Visual functions without the occipital lobe or after cerebral hemispherectomy in infancy

This paper investigates whether and to what extent vision with awareness is still possible in the whole visual field after loss of the occipital lobe of one or both cerebral hemispheres or after hemispherectomy in childhood. The visual functions of four children who suffered from unilateral or bilateral loss of the occipital lobe or who had been hemispherectomized were examined. The results show that even after unilateral loss of the striate and prestriate cortex the extent of the visual field may still be in the normal range. The residual visual functions may be mediated by intact extrastriate areas such as V5 and LO of the damaged cerebral hemisphere. It is also shown that even after complete hemispherectomy in early life the visual field may have a normal extent and that conscious visual perception in the whole visual field may be preserved. In hemispherectomized children, the remaining cerebral hemisphere or neural structures in the midbrain, including the superior colliculi and the praetectum, may be able to mediate these visual functions.

Conscious visual abilities in a patient with early bilateral occipital damage

A 21-year-old male presented with occipital lobes that were extensively damaged by bilateral infarcts present at birth. The absence of the striate cortex was confirmed with anatomic and functional MRI and high-resolution EEG. His cortical visual impairment was severe, but he retained a remarkable ability to see fast-moving stimuli. Horizontal optokinetic nystagmus could be elicited from either eye. Resolution acuity was close to normal providing the patient was allowed to move his head and eyes. The direction of motion in random-dot patterns could be discriminated with perfect accuracy at speeds above 2 deg/s, and the patient reported that he could 'see' the motion at fast but not at slow speeds. This conscious residual vision for motion is known as Riddoch's phenomenon, but it has never been reported in the complete absence of the striate cortex. Functional neuroimaging revealed activation that was outside the motion-responsive regions of the extrastriate cortex. This case demonstrates remarkable plasticity in the human visual system and may have implications for understanding the functional organization of the motion pathways.

Line bisection following hemispherectomy

Two left- and right-hemispherectomized patients with contralateral hemianopia and 20 normal controls were administered a line bisection task. All hemispherectomized patients showed a strong bisection bias towards their blind visual field. This contralateral bias persisted when patients were forced to start scanning within their blind hemifield, supporting the idea of a strategic adaptation of attention towards the blind visual field. In all patients the hemispherectomy was performed as a result of cortical abnormality (congenital or acquired) and therefore early changes in functional cerebral organization may have occurred in these patients. The absence of a neglect-like ipsilateral bias and the presence of a hemianopic-like contralateral bias in line may represent a functional deficit or suggest that plastic changes following hemispherectomy induced an adaptive functional re-organization of spatial attention in both left- and right-hemispherectomized patients.