Blast-induced axonal degeneration in the rat cerebellum in the absence of head movement

Blast exposure can injure brain by multiple mechanisms, and injury attributable to direct effects of the blast wave itself have been difficult to distinguish from that caused by rapid head displacement and other secondary processes. To resolve this issue, we used a rat model of blast exposure in which head movement was either strictly prevented or permitted in the lateral plane. Blast was found to produce axonal injury even with strict prevention of head movement. This axonal injury was restricted to the cerebellum, with the exception of injury in visual tracts secondary to ocular trauma. The cerebellar axonal injury was increased in rats in which blast-induced head movement was permitted, but the pattern of injury was unchanged. These findings support the contentions that blast per se, independent of head movement, is sufficient to induce axonal injury, and that axons in cerebellar white matter are particularly vulnerable to direct blast-induced injury.

Diffusion Tensor Imaging Studies on Recovery of Injured Optic Radiation: A Minireview

The optic radiation (OR) is a visual neural fiber pathway for the transfer of visual information from the lateral geniculate body of the thalamus to the primary visual cortex. To demonstrate the recovery of an OR injury, quantification and visualization of changes to the injured OR are necessary. Diffusion tensor imaging (DTI) allows determination of the state of an OR by assessing the obtained DTI parameters. In particular, diffusion tensor tractography (DTT), which is derived from DTI data, allows three-dimensional visualization of the OR. Thus, recovery of an injured OR can be demonstrated by examining changes in DTI parameters and/or configuration on follow-up DTI scans or via DTT of the injured OR. Herein, we review nine DTI-based studies that demonstrated recovery of OR injuries. The results reported in these studies suggest that an OR injury has a potential for recovery. Moreover, the results of these studies can form a basis for elucidating the recovery mechanisms of injured OR. These studies have suggested two recovery mechanisms for OR injury: recovery via the original OR pathway or via the transcallosal fibers of the corpus callosum. However, only nine studies on this topic have been conducted to date and six of those nine studies were case reports. Therefore, further studies involving larger numbers of subjects and reporting precise evaluations of changes in OR injury during recovery are warranted.

Neurorehabilitation of saccadic ocular movement in a patient with a homonymous hemianopia postgeniculate caused by an arteriovenous malformation: A Case Report

RATIONALE

Visual therapy, which includes a restorative and compensatory approach, seems to be a viable treatment option for homonymous defects of the visual field in patients with postgeniculate injury of the visual pathway, due to occipital arteriovenous malformation (AVM). Until now, the Mexican population suffering from homonymous hemianopia did not have health services that provided any type of visual therapy for their condition.

PATIENT CONCERNS

A 31-year-old patient, who underwent a surgical procedure for resection of the AVM, was referred with posterior low vision on the left side.

DIAGNOSES

The patient was diagnosed with left homonymous hemianopia.

INTERVENTIONS

Visual neurorehabilitation therapy (NRT), which integrated restorative and compensatory approaches, was administered for 3 hours each week. NRT included fixation, follow-up, search, peripheral vision, and reading.

OUTCOMES

The NRT did not change visual field defects and, retinotopocally, the same campimetric defects remained. However, after training the tracking ocular movements improved to standard values on the ENG, further, the visual search became more organized. The reading reached a level without mistakes, with rhythm and goog intonation. The Beck test demostrated an improvement in depression symptoms. Regarding the daily life activities, the patient reported significant improvements.

LESSONS

Visual NRT can significantly improve eye movements, as well as the quality of life and independence of the patient. This integral approach could be an effective therapeutic option for homonymous defects of the visual field.

Plasticity of the human visual brain after an early cortical lesion

In adults, partial damage to V1 or optic radiations abolishes perception in the corresponding part of the visual field, causing a scotoma. However, it is widely accepted that the developing cortex has superior capacities to reorganize following an early lesion to endorse adaptive plasticity. Here we report a single patient case (G.S.) with near normal central field vision despite a massive unilateral lesion to the optic radiations acquired early in life. The patient underwent surgical removal of a right hemisphere parieto-temporal-occipital atypical choroid plexus papilloma of the right lateral ventricle at four months of age, which presumably altered the visual pathways during in utero development. Both the tumor and surgery severely compromised the optic radiations. Residual vision of G.S. was tested psychophysically when the patient was 7 years old. We found a close-to-normal visual acuity and contrast sensitivity within the central 25° and a great impairment in form and contrast vision in the far periphery (40-50°) of the left visual hemifield. BOLD response to full field luminance flicker was recorded from the primary visual cortex (V1) and in a region in the residual temporal-occipital region, presumably corresponding to the middle temporal complex (MT+), of the lesioned (right) hemisphere. A population receptive field analysis of the BOLD responses to contrast modulated stimuli revealed a retinotopic organization just for the MT+ region but not for the calcarine regions. Interestingly, consistent islands of ipsilateral activity were found in MT+ and in the parieto-occipital sulcus (POS) of the intact hemisphere. Probabilistic tractography revealed that optic radiations between LGN and V1 were very sparse in the lesioned hemisphere consistently with the post-surgery cerebral resection, while normal in the intact hemisphere. On the other hand, strong structural connections between MT+ and LGN were found in the lesioned hemisphere, while the equivalent tract in the spared hemisphere showed minimal structural connectivity. These results suggest that during development of the pathological brain, abnormal thalamic projections can lead to functional cortical changes, which may mediate functional recovery of vision.

Injury of optic radiation and visual field defect in a patient with aneurysmal subarachnoid hemorrhage: A case report

RATIONALE

Little is known about optic radiation (OR) injury following aneurysmal subarachnoid hemorrhage (SAH). In the current study, we report on a patient who showed a visual field defect and injury of the OR following aneurysmal SAH, using diffusion tensor tractography (DTT).

PATIENT CONCERNS

At 4 weeks from onset, when a 62-year old female started rehabilitation, she complained of a visual field defect. Peripheral field defects were detected on both eyes using the Humphrey visual field test.

DIAGNOSES

The patient underwent aneurysm clipping for a ruptured aneurysm in the left posterior communicating artery and extraventricular drainage (the left prefrontal approach) for subarachnoid hemorrhage. She also underwent conservative management for intracerebral hemorrhage in the left internal capsule detected at 2 days after onset.

INTERVENTIONS

DTT data were acquired at 4 weeks after onset OUTCOMES:: Regarding DTT parameters, fiber numbers of both ORs of the patient were decreased over 2 standard deviations of that of 7 age- and sex-matched normal subjects normal control subjects. However, the value of fractional anisotropy was similar to that of normal control subjects. On the configuration of the OR of the patient, both ORs were thinner than those of normal control subjects.

LESSONS

Injury of the OR was demonstrated in a patient with a visual field defect following aneurysmal SAH, using DTT.

Elaboration of the Visual Pathways from the Study of War-Related Cranial Injuries: The Period from the Russo-Japanese War to World War I

As a result of the wars in the early 20th century, elaboration of the visual pathways was greatly facilitated by the meticulous study of visual defects in soldiers who had suffered focal injuries to the visual cortex. Using relatively crude techniques, often under difficult wartime circumstances, investigators successfully mapped key features of the visual pathways. Studies during the Russo- Japanese War (1904-1905) by Tatsuji Inouye (1881-1976) and during World War I by Gordon Holmes (1876-1965), William Lister (1868-1944), and others produced increasingly refined retinotopic maps of the primary visual cortex, which were later supported and refined by studies during and after World War II. Studies by George Riddoch (1888-1947) during World War I also demonstrated that some patients could still perceive motion despite blindness caused by damage to their visual cortex and helped to establish the concept of functional partitioning of visual processes in the occipital cortex.

Loss of sensory input causes rapid structural changes of inhibitory neurons in adult mouse visual cortex

A fundamental property of neuronal circuits is the ability to adapt to altered sensory inputs. It is well established that the functional synaptic changes underlying this adaptation are reflected by structural modifications in excitatory neurons. In contrast, the degree to which structural plasticity in inhibitory neurons accompanies functional changes is less clear. Here, we use two-photon imaging to monitor the fine structure of inhibitory neurons in mouse visual cortex after deprivation induced by retinal lesions. We find that a subset of inhibitory neurons carry dendritic spines, which form glutamatergic synapses. Removal of visual input correlates with a rapid and lasting reduction in the number of inhibitory cell spines. Similar to the effects seen for dendritic spines, the number of inhibitory neuron boutons dropped sharply after retinal lesions. Together, these data suggest that structural changes in inhibitory neurons may precede structural changes in excitatory circuitry, which ultimately result in functional adaptation following sensory deprivation.

Palinopsia From Posterior Visual Pathway Lesions Without Visual Field Defects

Palinopsia, or perseveration of a previously viewed image, may be caused by drug use or by posterior visual pathway lesions. Most cases of palinopsia due to visual pathway lesions have an associated homonymous hemianopic visual field defect. We report two patients with palinopsia caused by structural lesions of the posterior visual pathway in the absence of visual field defects. Patients with palinopsia should undergo neuroimaging even in the presence of normal visual fields.

Visual field preservation after multisession cyberknife radiosurgery for perioptic lesions

OBJECTIVE

The restricted radiation tolerance of the anterior visual pathways represents a unique challenge for ablating adjacent lesions with single-session radiosurgery. Although preliminary studies have recently demonstrated that multisession radiosurgery for selected perioptic tumors is both safe and effective, the number of patients in these clinical series was modest and the length of follow-up limited. The current retrospective study is intended to help address these shortcomings.

METHODS

Forty-nine consecutive patients with meningioma (n = 27), pituitary adenoma (n = 19), craniopharyngioma (n = 2), or mixed germ cell tumor (n = 1) situated within 2 mm of a "short segment" of the optic apparatus underwent multisession image-guided radiosurgery at Stanford University Medical Center. Thirty-nine of these patients had previous subtotal surgical resection, and six had previously been treated with conventional fractionated radiotherapy (6). CyberKnife radiosurgery was delivered in two to five sessions to an average tumor volume of 7.7 cm3 and a cumulative average marginal dose of 20.3 Gy. Formal visual testing and clinical examinations were performed before treatment and at follow-up intervals beginning at 6 months.

RESULTS

After a mean visual field follow-up of 49 months (range, 6-96 mo), vision was unchanged postradiosurgery in 38 patients, improved in eight (16%), and worse in three (6%). In each instance, visual deterioration was accompanied by tumor progression that ultimately resulted in patient death. However, one of these patients, who had a multiply recurrent adrenocorticotropic hormone-secreting pituitary adenoma, initially experienced early visual loss without significant tumor progression after both a previous course of radiotherapy and three separate sessions of radiosurgery. After a mean magnetic resonance imaging follow-up period of 46 months, tumor volume was stable or smaller in all other cases. Two patients died of unrelated nonbrain causes.

CONCLUSION

Multisession radiosurgery resulted in high rates of tumor control and preservation of visual function in this group of perioptic tumors. Ninety-four percent of patients retained or improved preradiosurgical vision. This intermediate-term experience reinforces the findings from earlier studies that suggested that multisession radiosurgery can be a safe and effective alternative to either surgery or fractionated radiotherapy for selected lesions immediately adjacent to short segments of the optic apparatus.

MR tractography predicts visual field defects following temporal lobe resection

A superior homonymous quadrantanopia is a well recognized complication of anterior temporal lobe resection and occurs because of disruption of the Meyer loop, the anterior part of the optic radiation. The authors used diffusion tensor imaging tractography to visualize the optic radiation before and after surgery, demonstrating the disruption of Meyer loop in a patient who developed a quadrantanopia. Preoperative imaging of the optic radiation will be useful in predicting visual field defects following temporal lobe resection.

No effect of hippocampal lesions on perirhinal cortex-dependent feature-ambiguous visual discriminations

Previous studies have shown that perirhinal cortex lesions in monkeys impair visual discriminations with a high degree of "feature ambiguity," a property of visual discriminations that can emerge when features are a part of both rewarded and unrewarded stimuli. The effects of damage to the hippocampus on these perirhinal-dependent feature-ambiguous tasks are, however, unknown. Prominent theories of medial temporal lobe function predict similar effects of perirhinal cortex and hippocampal lesions on cognitive tasks. In contrast, our hypothesis is that perirhinal cortex, and not the hippocampus, is important for nonspatial complex feature-ambiguous discriminations. We sought to distinguish between these competing theories in a straightforward way, by testing rhesus monkeys with hippocampal lesions on the same feature-ambiguous tasks shown previously to depend on perirhinal cortex. It was found that hippocampal lesions had no effects on any of these tasks. The findings support the perceptual-mnemonic/feature conjunction model of perirhinal cortex function, and provide further evidence for heterogeneity of function within the putative medial temporal lobe memory system.

Recruitment of local excitatory circuits in the superior colliculus following deafferentation and the regeneration of retinocollicular inputs

The local synaptic connectivity in the superficial gray layer of the superior colliculus (SC) was assessed following retinal ganglion cell axonal regeneration through a peripheral nerve graft into the SC of Lister Hooded rats, using in vitro brain slice techniques. Repair was effected between the ipsilateral eye and SC, following bilateral lesion of optic nerves and ablation of ipsilateral occipital cortex. Deafferentation surgery alone resulted in a complete loss of synaptic potentials of extrinsic origin, once both retinal and cortical inputs were removed. Stimulation of graft insertion sites elicited synaptic responses comprising monosynaptic and network-mediated depolarising events. This activity, together with similar spontaneous bursts of depolarising events and action potential firing, was generated by the activation of non-N-methyl-D-aspartate glutamate receptors. This behaviour may reflect the development of a local recurrent synaptic connectivity following the repair surgery, as both evoked and spontaneous responses developed into large long-lasting bursts of excitatory activity when inhibition mediated by GABA receptors was blocked. These results suggest that the ultrastructural changes in the superficial layers of the SC resulting from deafferentation are reflected functionally at the synaptic level in the target structure even after repair. Such changes are likely to compromise the ability of the target structure to function normally during information processing. Therefore, although axons regenerating along peripheral nerve grafts can make functional synaptic connections, their efficacy in activating the target structure will probably be compromised by local changes in synaptic connectivity.

Impaired spatial coding within objects but not between objects in prosopagnosia

BACKGROUND

Patients with prosopagnosia from occipitotemporal lesions have impaired perception of the configuration of facial features. This may be an example of impaired "within-object" spatial coding, which others propose to be distinct from "between-object" spatial coding.

OBJECTIVE

To determine whether the prosopagnosic deficit in perceiving spatial configuration was specific to within-face and not between-face spatial coding and whether the deficit was face-selective or extended to objects other than faces.

METHODS

Six prosopagnosic patients were tested using an oddity paradigm in which they detected which of three simultaneously seen stimuli was an altered target. In the "within-face" task, the target face had altered interocular distance or mouth position. In the "between-face" task, the target face was located farther away from the other two. In the "within-object" task, the stimulus was a two-dot pattern, and the target pattern had altered interdot distance.

RESULTS

Spatial judgments were impaired within faces for all six patients and within the two-dot pattern for five of six patients. However, all six had normal between-face spatial perception.

CONCLUSIONS

Impaired perception of spatial relations in prosopagnosia is selective to the spatial structure within individual objects and spares the perception of spatial location of objects. It is not specific to faces. It reveals a process involved in analyzing object structure, consistent with the patients' deficits in recognizing facial identity, and illustrates a different type of "visuospatial" defect.

Remote effect of optic tract trauma in the occipital lobe (case report)

Traumatic brain damage can result in severe visual impairments including hemianopia. Lesions correlated with hemianopia can be located in any part of the retrochiasmatic optic pathway. However, traumatic lesions of the optic tract are relatively rare. We present a case with posttraumatic left homonymous hemianopia who had signal intensity change at the ipsilateral optic tract on MR imaging and ipsilateral occipital hypoperfusion on SPECT imaging.

Sensory and response contributions to visual awareness in extinction

Brain-damaged patients may extinguish contralesional stimuli when ipsilesional stimuli are presented simultaneously. Most theories of extinction postulate that stimuli compete for pathologically limited attentional resources with a bias to process ipsilesional over contralesional stimuli. Implicit in this view is the idea that responses follow the outcome of an earlier competition between inputs. In the current study of two patients, we used signal detection analyses to test the hypothesis that response criteria and response modalities also contribute to visual awareness. We found that identification was more sensitive than detection in uncovering deficits of contralesional awareness. Extinction was worse with bilateral stimuli when the ipsilesional stimulus was identical or similar to the target than when it was dissimilar. This diminished awareness was more likely to reflect a shift towards more conservative responses rather than diminished discrimination of contralesional stimuli. By contrast, one patient was better able to discriminate contralesional stimuli when using his contralesional limb to indicate awareness of targets than when using his ipsilesional limb. These data indicate that the nature of stimuli can modulate response criteria and the motor response can affect the sensory discriminability. Sensory discrimination and response output are not organized in a simple serial manner. Rather, input and output parameters interact in complicated ways to produce visual awareness. Visual awareness itself appears to be the outcome of two bottlenecks in processing, one having to do with sensory processing that may be covert and the other having to do with decision making, which by definition is overt. Finally, we advocate the use of signal detection analyses in studies of extinction, a method that has been surprisingly neglected in this line of research.

[Study on prevention and treatment of radiotherapy caused post-visual pathway injury in nasopharyngeal carcinoma patients by traditional Chinese medicine]

OBJECTIVE

To study the effect of TCM in preventing and treating post-visual pathway injury caused by radiotherapy (RT) for nasopharyngeal carcinoma (NPC).

METHODS

Thirty-five patients of NPC were randomly divided into the RT group (n = 17) and the RT + TCM group (n = 18), they were all received RT, but the latter was treated additionally with Jingming recipe, a Chinese recipe. The latent period and amplitude of evoked potential (EP) were measured before and after ending of RT, using multi-focusing visual evoked potential inspector.

RESULTS

The latent time of EP, both upper and lower visual field, was prolonged significantly after RT in the RT group (P < 0.05), but not in the RT + TCM group (P > 0.05); the amplitude of EP of upper visual field lowered significantly (P < 0.05) in the RT group but insignificantly in the RT + TCM group (P > 0.05); as for the EP amplitude of lower visual field, it was unaltered in RT group after RT (P > 0.05), but increased in the RT + TCM group (P < 0.05).

CONCLUSION

The Chinese medicine Jingming recipe was effective in preventing and treating RT induced post-visual pathway injury.

Apoptosis and retinal projections in the dorsal lateral geniculate nucleus after monocular deprivation during the later phase of the critical period in the rat

The visual cortex in the rat is matured physiologically by postnatal day 30, but the visual system retains the potential to be reorganized until postnatal day 45. Therefore, we defined the period from postnatal days 28-45 as the 'late critical phase'. To examine whether monocular deprivation during the late critical phase gives rise to neuronal apoptosis in the dorsal lateral geniculate nucleus (dLGN), we used the terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end-labeling method and anterograde tracing. The number of apoptotic cells in the dLGN after monocular deprivation at postnatal day 28 showed little difference from control at postnatal day 29, but was significantly increased to more than fourfold of control ipsilaterally to the monocular deprivation at postnatal day 35 and to more than 10-fold of control bilaterally at postnatal day 40. In the control, there were almost no apoptotic neurons in the dLGN on either side at postnatal day 40. In the nucleus ipsilateral to the monocular deprivation, approximately half the apoptotic neurons were found in an area that did not receive a retinal projection. These findings suggest that the biological process of increased apoptosis in the dLGN of rats that received monocular deprivation in the late critical phase may be different from that in the early critical phase. The increased number of apoptotic cells in the dLGN in the late critical phase may not be simply the result of monocular deprivation.

Molecular cloning and differential expression of the cat immediate early gene c-fos

Recently, the effect of binocular central retinal lesions on the expression of immediate early genes in the visual system of adult cats was demonstrated using in situ hybridization and immunocytochemistry. The present study was undertaken to quantify cat c-fos mRNA expression differences in the cat primary visual cortex after sensory deafferentation. Prior to quantification, DNA fragments obtained using reverse transcription-polymerase chain reaction (RT-PCR) in combination with rapid amplification of complementary DNA ends (RACE) were cloned and sequenced. This provided us with the necessary sequence(1) information to prepare cat-specific c-fos primers for the development of a new quantitative RT-PCR assay. We optimized a reverse transcription-competitive polymerase chain reaction (RT-cPCR) method with a heterologous DNA fragment (competitor) as external standard to quantify relative amounts of cat c-fos mRNA expression levels. Internal standardization was accomplished by quantifying, in a parallel RT-cPCR, a well-characterized housekeeping gene, glyceraldehyde-3-phosphate dehydrogenase (GAPDH). This cat-specific RT-cPCR assay allowed us to measure c-fos mRNA expression levels in central and peripheral regions of primary visual cortex in normal and retinal lesion cats.

Quantifying presynaptic terminals at the light microscope level in intact and deafferented central nervous structures

Quantification of presynaptic terminals often requires laborious techniques that involve tissue preparation for ultrastructural analysis. Modern preembedding immunohistochemical techniques provide a high morphological resolution at the light microscope level, thus allowing us to identify immunostained presynaptic boutons using specific antibodies. When absolute density of boutons (D(a)) is analysed for comparison between control and deafferented nervous tissue, quantification may be distorted due to tissue shrinkage that follows deafferentiation. The magnitude of this effect must be, therefore, estimated to correct quantitative data. Using the superior colliculus (SC) as a model, an easily applicable protocol to quantify the density of small size labelled particles in control and deafferented nervous tissue is described. This protocol was used to analyse the effect of neonatal and adult enucleation on the adult pattern of cholinergic input to the rat SC. Statistical treatment of data demonstrated that neonatal enucleation caused a drastic increase in bouton density in the visual collicular layers, stratum zonale (SZ) and stratum griseum superficiale (SGS). The same lesion carried out in adult animals caused an increase in the bouton density exclusively in the SZ.

Neural basis of prosopagnosia: an fMRI study

Brain imaging research has identified at least two regions in human extrastriate cortex responding selectively to faces. One of these is located in the mid-fusiform gyrus (FFA), the other in the inferior occipital gyrus (IOG). We studied activation of these areas using fMRI in three individuals with severely impaired face recognition (one pure developmental and two childhood prosopagnosics). None of the subjects showed the normal pattern of higher fMRI activity to faces than to objects in the FFA and IOG or elsewhere. Moreover, in two of the patients, faces and objects produced similar activations in the regions corresponding to where the FFA and IOG are found in normal subjects. Our study casts light on the important role of FFA and IOG in the network of areas involved in face recognition, and indicates limits of brain plasticity.

Plasticity of the visual cortex after injury: what's different about the young brain?

The repercussions of localized injury of the cerebral cortex in young brains differ from the repercussions triggered by equivalent damage of the mature brain. In the young brain, some distant neurons are more vulnerable to the lesion, whereas others survive and expand their projections to bypass damaged and degenerated structures. The net result is sparing of neural processing and behaviors. This article summarizes both the modifications in visual pathways resulting from visual cortex lesions sustained early in life and the neural and behavioral processes that are spared or permanently impaired. Experiments using reversible deactivation show that at least two highly localizable functions of normal cerebral cortex are remapped across the cortical surface as a result of an early lesion of the primary visual cortex. Moreover, the redistributions have spread the essential neural operations underlying orienting behavior from the visual parietal cortex to a normally functionally distinct type of cortex in the visual temporal system, and in the opposite direction for complex-pattern recognition. Similar functional reorganizations may underlie sparing of neural processes and behavior following early lesions in other cerebral systems, and these other systems may respond well to emerging therapeutic strategies designed to enhance the sparing of functions.

Expression of BCL-2 via adeno-associated virus vectors rescues thalamic neurons after visual cortex lesion in the adult rat

Lesions of the mammalian visual cortex cause the retrograde degeneration of the thalamic neurons projecting to the damaged cortex. The proto-oncogene bcl-2 is known to inhibit neuronal apoptosis induced by a variety of noxious stimuli and preserve the functional integrity of the injured cells. Here we have tested whether the overexpression of bcl-2 via adeno-associated virus (AAV) vectors is able to protect the neurons in the lateral geniculate nucleus after visual cortex ablation in adult rats. Recombinant AAV vectors encoding Bcl-2 (AAV-Bcl-2) or green fluorescent protein (AAV-GFP) as a control were stereotaxically injected into the geniculate. Three weeks after vector injection, the ipsilateral visual cortex was removed by aspiration, and cell survival was assessed 2 weeks later. We found that 20% of the geniculate neurons were transduced by the Bcl-2 vector. These cells were completely protected from death following cortical ablation. Delivery of AAV-GFP transduced an identical number of geniculate neurons but had no effect on cell survival after lesion. The total number of surviving geniculate neurons was found to be significantly higher in animals injected with AAV-Bcl-2 than in rats injected with AAV-GFP or in control lesioned rats. These data indicate that Bcl-2 gene therapy with AAV vectors represents an effective treatment to promote neuronal survival after central nervous system insults.

Cross-modal neuroplasticity in neonatally enucleated hamsters: structure, electrophysiology and behaviour

Potential auditory compensation in neonatally bilaterally enucleated Syrian hamsters was explored anatomically, electrophysiologically and behaviourally. Gross morphology of the visual cortex appeared normal and no obvious cytoarchitectural malformation was discerned. However, enucleation induced a significant increase in the spontaneous firing rate of visual cortex cells. Further, auditory stimuli elicited field potentials and single unit responses in the visual cortex of enucleated, but not normal, animals. About 63% of the cells isolated in the visual cortex of 16 enucleated hamsters responded to at least one type of auditory stimulus. Most of the responses were less vigorous and less time-locked than those of auditory cortex cells, and thresholds were typically higher. Projection tracing with WGA-HRP disclosed reciprocal connections between the visual cortex and the dorsal lateral geniculate nucleus in both intact and enucleated animals. However, in the enucleated animals retrogradely labelled cells were also found in the inferior colliculus, the major midbrain auditory nucleus. Behaviourally determined auditory sensitivity across the hearing range did not differ between enucleated and intact hamsters. Minimum audible angle, as determined by a conditioned suppression task, ranged from around 17 to 22 degrees, with no significant difference between normal and enucleated animals. The two groups also did not differ with regard to the direction of their unconditioned head orientating response to intermittent noise. However, the enucleated animals showed a more vigorous response and were slower to habituate to the noise. These results show that bilateral enucleation of newborn hamsters results in auditory activation of visual targets, in addition to the typical activation of the intact auditory pathway. Behaviourally it appears that enucleated hamsters, compared with their normal littermates, are slower to habituate in their response to an unexpected source of sound.

Perinatal cortical and subcortical visual loss: mechanisms of injury and associated ophthalmologic signs

PURPOSE

To determine whether term and preterm injuries to the retrogeniculate visual system are associated with recognizable patterns of ophthalmologic abnormalities and whether these patterns can be attributed to cortical (gray matter) or subcortical (white matter) injury.

DESIGN

A retrospective case series.

PARTICIPANTS

One hundred children with clinical and neuroimaging signs of perinatal posterior visual pathway injury who were examined at Arkansas Children's Hospital Eye Clinic between 1989 and 1999.

METHODS

We reviewed magnetic resonance images or computed tomographic scans from 50 children with cortical (predominantly or exclusively involving cortical gray matter) and 50 children with subcortical (predominantly or exclusively involving subcortical white matter) perinatal injury to the retrogeniculate visual system. Ophthalmologic abnormalities were analyzed retrospectively in each group.

MAIN OUTCOME MEASURES

Conjugate gaze deviation, type of strabismus, abnormal eye movements, and optic disc morphology.

RESULTS

Horizontal conjugate gaze deviation, exotropia, and a normal optic disc appearance were significantly more common in cortical than in subcortical visual loss. Tonic downgaze, esotropia, and optic nerve hypoplasia (with or without coexisting pallor) were significantly more common in subcortical than in cortical visual loss.

CONCLUSIONS

Perinatal cortical and subcortical visual loss produce differing profiles of ophthalmologic dysfunction. A reclassification of periventricular leukomalacia and other forms of retrogeniculate white matter injury as subcortical visual loss would increase diagnostic specificity.

Behavioral responses to light in mice with dorsal lateral geniculate lesions

Light has rapid direct effects on behavior and physiology that may be distinguished from its indirect effects that occur via synchronization of the biological clock. In nocturnal animals, light at night acutely suppresses the wheel running activity usually observed at that time of day. This is known as masking because light masks the overt expression of the circadian activity rhythm. In the present study, we compared the effects of light on wheel running in mice with bilateral electrolytic lesions of the dorsal lateral geniculate nucleus (DLG) to those in sham-operated animals. DLG-lesioned animals exhibited greater suppression of wheel running in response to bright light than did the controls, but failed to exhibit the increased activity in response to dim light observed in intact animals. These findings support the view that masking effects of light on behavior comprise two opposing processes, one that increases activity and is mediated by the classical visual system, and another that suppresses activity and is mediated by a non image-forming irradiance detection system.

Capturing the circadian rhythms of free-running blind people with 0.5 mg melatonin

We have recently shown that six of seven totally blind people (who had free-running circadian rhythms with periods longer than 24 h) could be entrained (synchronized) to a nightly dose of 10 mg melatonin. After treatment discontinuation and re-entrainment to the 10 mg dose, we further found in three of these subjects that the dose could be gradually reduced to 0.5 mg without loss of effect. The question then arose: can a de novo (starting) dose of 0.5 mg initially capture free-running rhythms? Following withdrawal of the stepped-down 0.5 mg dose and consequent release into a free-run, the same three individuals were given 0.5 mg of melatonin de novo. All entrained within a few weeks.

The regional cortical basis of achromatopsia: a study on macaque monkeys and an achromatopsic patient

Previous experiments have revealed total loss of colour vision following removal of all inferior temporal cortex, a condition akin to complete cerebral achromatopsia in humans. Whether less extensive ablation genuinely impairs colour perception without abolishing it or retards learning involving coloured stimuli is contested. We therefore tested macaque monkeys, with total removal of temporal areas TEO and TE but sparing rostral and perirhinal temporal cortex and the upper bank of the superior temporal sulcus. Compared with three monkeys with lateral parietal ablations, the monkeys with TEO/TE lesions were impaired at learning and retention of simultaneous two-choice colour discriminations and with a nine-choice oddity discrimination whether the coloured target was embedded among grey distracters of the same luminance or among isoluminant coloured distracters. However, their performance was superior to that of an achromatopsic human subject and to that previously measured in monkeys with much larger temporal lobe ablation. They were only mildly impaired at nine-choice oddity discrimination for grey stimuli where the grey target was brighter than the grey distracters. The impairment could be exacerbated or alleviated by altering the colour of the background of the displays and by static and dynamic luminance masking of the entire display in a manner that indicates that the colour deficit reflects a change in perception rather than a disorder of learning and memory. It resembles central dyschromatopsia in human subjects but falls short of achromatopsia.

Detection and discrimination of chromatic targets in hemianopic macaque monkeys and humans

We measured the ability of three macaque monkeys with unilateral removal of primary visual cortex to detect 9 degrees, 200-ms targets presented at random in the upper or lower quadrants of the normal and hemianopic visual fields. The white or variously coloured target could differ from the background in both colour and luminance, or in either of them. Blue and red targets were detectable at any luminance contrast, but green and white targets were barely or not at all detectable at and near isoluminance in the hemianopic field. Blue and red targets were better detected than white targets at the same luminance difference. However, when both the target and the background were dynamically luminance-masked, detection in the hemianopic field failed at isoluminance whatever the colour. In addition, the monkeys were unable to discriminate between simultaneously presented red and green or blue and green targets in the hemianopic field when both targets had similar luminance contrast with the background. Two hemianopic patients tested on a subset of the tasks performed similarly to the monkeys. Together, the results indicate that the residual colour-opponent system that survives damage to V1 is involved in the detection of chromatic changes but cannot sustain simultaneous discrimination between pairs of colours.

The variety of visual perceptual impairments in pre-school children with perinatal brain damage

To study the selectivity of visual perceptual impairment in children with early brain injury, eight visual perceptual tasks (L94), were administered to congenitally disabled children both with and without risk for cerebral visual impairment (CVI). The battery comprised six object-recognition and two visuoconstructive tasks. Seven tasks were newly designed. For these normative data are presented (age 2.75-6.50 years). Because the recognition tasks required object naming, each item included a canonical control drawing and visual perceptual ability was evaluated relative to the non-verbal intelligence level, instead of chronological age. In 22 multiple disabled children with no indications of CVI, the frequency of impairment did not exceed that in the reference sample for any L94 task. In contrast, in 57 5-year-old children who were at risk for CVI due to pre-maturity or birth asphyxia, a significant increase in the frequency of impairment was seen on six L94 tasks (range 12-38%). However, only five children had more than two impairments, indicating that the deficits were selective, not pervasive. We conclude that early brain lesions interfere with the functioning of particular visual subsystems, yet leave other subsystems intact and functioning within the normal range.

Interhemispheric transfer time in a patient with a partial lesion of the corpus callosum

The interhemispheric transfer time (ITT) of basic visuo-motor integration was investigated in a patient who had a lesion of the corpus callosum that spared the splenium and rostrum. Overall, 4291 simple reaction times were collected during unimanual responses to tachistoscopically presented lateralized simple visual stimuli at 4 degrees, 6 degrees and 10 degrees. Despite retaining some abilities that typically require the integration of information between hemispheres (e.g. haptic naming, tachistoscopic lateralized consonant reading) the patient performed similarly to completely callosotomized patients in a basic visuo-motor ITT task (overall 25.5 ms) at any eccentricity. These findings suggest that specific callosal channels mediate the basic visuo-motor ITT and these do not include the rostrum and/or the splenium of the corpus callosum.

Damage to intracranial optic pathways in fatal closed head injury in man

Head injury is a leading cause of visual impairment. This is partly due to direct trauma to the eye and optic nerve but much of the damage involves the intracranial optic pathways. We have studied the frequency, distribution and nature of the intracranial lesions of the optic pathways at autopsy in 45 cases of severe closed head injury, and examined the correlation between these post-mortem lesions and the ante-mortem clinical findings. Twenty-four of the patients had been involved in road traffic accidents. The ages ranged from 9 to 88 years (mean 46.4), the Glasgow Coma Score (GCS) on admission ranged from 3 to 15 (mean 5), and the survival time after injury from 2.5 h to15 days (mean 3.3 days). Skull fractures were present in 75.6% of the cases. Histological assessment included the use of immunohistochemistry for beta-amyloid precursor protein (beta-APP) and the microglial marker CD68. Axonal injury of varying severity was demonstrable in all cases, and in 39 (87%) the optic chiasm, tracts or radiations were involved, usually in more than one region. The severity of axonal injury was mild in 11 (24%), moderate in 9 (20%) and severe in 19 (42%) cases. The optic radiation at the level of the trigone of the lateral ventricle was particularly frequently and severely affected. The least affected parts of the intracranial optic pathways were the optic chiasm and the posterior segment of the optic nerve. The severity of injury to the optic pathways did not always reflect severity of axonal injury elsewhere in the brain and correlated poorly with the type of trauma (high- or low-velocity), presence of skull fractures or evidence of raised intracranial pressure (ICP). Of the 39 patients who survived more than 6 h, histological evidence of ischaemic injury to the primary optic cortex was present in 26 (67%) and was severe in 12. We conclude that the visual pathways are affected in a high proportion of patients with fatal closed head injury, nerve fibres in the optic radiations being particularly vulnerable. The findings suggest that damage to the posterior parts of the optic pathways may be under-diagnosed among patients with head injury.

Microelectrode recordings define the ventral posteromedial pallidotomy target

The benefits of stereotactic ventral posteromedial pallidotomy in the treatment of Parkinson's disease have been recently rediscovered. Optimal lesion location and lesion volume, however, have yet to be determined. Micro-electrode recording and microstimulation are carried out to determine an appropriate site for the placement of electrocoagulation lesions in the medial pallidum. The cellular activity of the globus pallidus is examined for characteristic firing patterns, mean firing rates, movement-evoked activity, and presence of tremor cells, laminae, and border zones. Microstimulation allows the identification of the adjacent optic tract by reports of visual sensation and of the internal capsule by sensorimotor responses. Lesions are centred at sites in the internal segment of the globus pallidus at least 3 mm from these structures, to avoid injury to them during pallidotomy.

[Controversies and current status of therapy of optic nerve damage in craniofacial traumatology and surgery]

In craniomaxillofacial traumatology, surgical oncology and craniomaxillofacial reconstruction, a surgeon's aim may interfere with the prechiasmatic visual pathway. Precise concepts and therapeutic strategies are mandatory to detect and deal with anterior visual pathway disorders. In order to develop these strategies, knowledge of the pathomechanisms of potential optic nerve trauma, primary radiological investigations, and further diagnostic measures are important. Due to the difficulties in neuroophthalmological testing of visual pathway functioning in severely injured patients or even during craniomaxillofacial reconstructions, we established flash-evoked visual potentials (VEP) and the electroretinogram (ERG) as reliable electrophysiological methods to gather specific information as to whether the visual pathway function is intact, even if pathological, but still present or absent. Case reports show that subjectively or objectively confirmed unilateral amaurosis does not necessarily mean irreversible vision loss. The electrophysiological evaluation together with multiplanar computer tomography (CT) are important for the immediate identification of optic nerve trauma. The results of this evaluation will provide the diagnostic information on whether surgical intervention and/or conservative therapy is required to prevent secondary optic nerve damage. The conservative therapy of choice for the treatment of traumatic optic nerve lesions is the methylprednisolone-megadosis regimen (30 mg Urbason/kg bodyweight i.v. and 5.4 mg/kg bodyweight/h i.v. for the following 47 h). Surgical therapy involves decompression of the orbital compartment in case of retrobulbar hematoma or decompression of the intracanalicular part of the optic nerve in the traumatized optic canal or posterior orbit as confirmed by CT. Prospective analysis of our trauma patients and the international literature on traumatic optic nerve lesions show that the time factor in when to start therapy has been greatly underestimated. To fulfill modern treatment concepts in craniomaxillofacial surgery, sound diagnostic and therapeutic knowledge on the maintenance of visual pathway function is required.

Neuro-ophthalmology of trauma

This review focuses on neuro-ophthalmic disorders caused by trauma. Most articles discussed were published after 1995. The review is divided into sections according to the anatomical sites that can be affected by trauma and lead to neuro-ophthalmic symptoms. The topics are the oculomotor nerves and the facial nerve, the cavernous sinus, the orbit, the optic nerve, and the brain. Treatment options are discussed, including strabismus surgery, orbital reconstruction, and medical as well as surgical treatment of traumatic optic neuropathy.

[Clinical and experimental study of traumatic optic nerve damage]

BACKGROUND

Traumatic optic nerve lesions (TONL) range from temporary affection of vision to avulsion of the optic nerve; often they are associated with more complex injuries. Usually Tonl are not regarded as an emergency. Up to now, we lack knowledge on the dependency of strength and duration of optic nerve lesions and the point of no return for afferent disorders of the visual pathway.

MATERIALS AND METHODS

We performed a prospective study on 50 patients with severe midface and skullbase fractures in order to find characteristic ophthalmological, computer tomographic und electrophysiological findings as indicators of TONL, independent of patient cooperation. We used an animal model (Wistar rats; n = 117) to study calibrated optic nerve lesions and the resulting neurodegeneration in the retinal ganglion cell (RGC) layer quantitatively.

RESULTS

The electrophysiological investigation of the visual system (flash VEP/ERG) proved to be highly specific (0.97) and sensitive (1.0) for detecting TONL (n = 18). In the rat model, we could demonstrate a linear relationship between total neuron number reduction and strength and duration of calibrated optic nerve lesion.

CONCLUSIONS

Experimental results indicate that optic nerve decompression is useful only within the first hours after TONL to reduce secondary optic nerve lesion. Indication for optic nerve decompression requires early detection of TONL, which is made possible by the combination of flash VEP/ERG.

Cortical dynamics

Our ability to interpret visual scenes involves assembling the components of objects into a unified percept and segregating them from background, storing information about earlier visual experiences and testing our interpretations of the visual world against incoming sensory input. The influences of context, experience and expectation are reflected in the response properties of cells at early stages in the visual pathway. The responses of cells in primary visual cortex depend not only on the attributes of features lying within the classical receptive field but also on the global characteristics of the contours and surfaces within which these features are embedded. The substrate for lateral interactions includes a plexus of long-range horizontal connections within each cortical area that links columns of similar orientation specificity and cells with widely separated receptive fields. The horizontal connections also play a role in the plasticity of receptive field structure and of cortical functional architecture, induced over long time scales by retinal lesions and over short time scales by patterned visual stimulation. The long-term changes are associated with synaptogenesis; and the short-term changes with an increase in synaptic effectiveness. The dynamics of cortical function persist throughout adulthood and are general to all cortical areas, including primary sensory cortices.

Visual electrodiagnostic findings in mild traumatic brain injury

Patients with traumatic brain injury (TBI) frequently exhibit varied forms of visual system dysfunction including: binocular, oculomotor, accommodative, refractive error shift, visual field loss, and visual perceptual deficits. A 5-year collaborative study between optometry and ophthalmology was initiated to follow documented mild TBI patients utilizing diagnostic methods to assess the quantity and quality of visual system deficits and recovery. A group of patients with mild TBI receiving optometric rehabilitation were compared with a group of age-matched, gender-matched, and headsize-matched TBI patients not receiving such treatment. Eighteen patients diagnosed with mild TBI underwent a treatment regimen of optometric rehabilitation (group I); 32 patients diagnosed with mild TBI did not receive optometric rehabilitation (group II). Pattern visually evoked cortical potential (VECP) testing and electroretinography (ERG) evaluation were utilized initially, repeated 6-12 months later and then 12-18 months after baseline. All TBI patients' VECP and ERG results were compared to age-matched, headsize-matched controls. Once the ERG had been used to exclude retinal involvement, identification of visual pathway dysfunction was possible with the VECP. Full-field ERG results in all groups were not remarkable and not sensitive for patients with mild TBI. Initial testing results revealed that 72% of those TBI patients in group I demonstrated VECP waveform abnormalities and 81% of those patients in group II showed waveform dysfunction. In the testing performed 12-18 months later, 38% of group I TBI patients, after receiving a treatment regimen of optometric rehabilitation, showed VECP waveform abnormalities; 78% of group II TBI patients demonstrated waveform abnormalities. VECP evaluation in patients with mild TBI can provide a useful and reliable tool for objective assessment of visual system deficit and recovery. Significant differences in visual system recovery were shown when comparing group I and group II.

Injury to anterior optic pathways

Fourteen patients with injury to the anterior optic pathways have been presented and analysed. Their clinical profile, radiological data and problems involved therein have been discussed. Since an expectant policy has been the rule so far, an attempt has been made to define the role of surgery in such cases.

Lightning and electrical injuries: neuro-ophthalmologic aspects

Lightning and electrical injuries have widespread manifestations involving almost all organ systems of the body, including the central nervous system (CNS) and the eye. This article considers the neuro-ophthalmologic effects of lightning and electrical injury.

Channels of the corpus callosum. Evidence from simple reaction times to lateralized flashes in the normal and the split brain

We studied 75 normal subjects and three commissurotomized patients using unimanual simple reaction times to lateralized flashes as a behavioural estimate of interhemispheric transmission time. Three different versions of the paradigm were performed: (i) the basic task; (ii) a motor task, with an increased complexity of the motor response; and (iii) a visual task, with an increased complexity of the visual stimulus presentation. We tested two hypotheses. First, that the new versions of the simple reaction time task result in shifts in hemispheric specialization for processing motor output (indicated by a main effect of response hand) or visual input (indicated by a main effect of visual field) alone, without affecting callosal transmission. In that case normals and split brain patients would show no significant task by response hand by visual field interaction and no significant task by crossed-uncrossed difference interaction. Secondly, that the new versions of the task affect callosal transfer. In that case, normals, but not split brain patients, would show a significant task by response hand by visual field interaction and a significant task by crossed-uncrossed difference interaction. Results are consistent with the latter hypothesis, showing that the motor task significantly changed the response hand by visual field interaction and the crossed-uncrossed difference, but only in normal subjects, perhaps producing a switch in the callosal channel subserving the interhemispheric transfer.

Receptive-field properties of deafferentated visual cortical neurons after topographic map reorganization in adult cats

When neurons in primary visual cortex of adult cats and monkeys are deprived of their normal sources of activation by matching lesions in the two retinas, they are capable of acquiring new receptive fields based on inputs from regions of intact retina around the lesions. Although these "reactivated" neurons respond to visual stimuli, quantitative studies of their response characteristics have not been attempted. Thus, it is not known whether these neurons have normal or abnormal features that could contribute to or disrupt an analysis of a visual scene. In this study, we used extracellular single-unit recording methods to investigate their stimulus selectivity and responsiveness. Specifically, we measured the sensitivity of individual neurons to stimulus orientation, direction of drift, spatial frequency, and contrast. Over 98% of all units in the denervated zone of cortex acquired new receptive fields after 3 months of recovery. Newly activated units exhibited strikingly normal orientation tuning, direction selectivity, and spatial frequency tuning when high-contrast (< 40%) stimuli were used. However, contrast thresholds of most neurons were abnormally elevated, and the maximum response amplitude under optimal stimulus conditions was significantly reduced. The results suggest that the striate cortical neurons reactivated during topographic reorganization are capable of sending functionally meaningful signals to more central structures provided that the visual scene contains relatively high contrast images.

Distribution and density of monoamine receptors in the primate visual cortex devoid of retinal input from early embryonic stages

Developmental mechanisms that regulate the areal and laminar distribution of various macromolecules, including neurotransmitter receptors in the cerebral cortex, are not known. In the present study, we examined the development of monoaminergic receptors in the rhesus monkey striate and peristriate visual cortex in the absence of input from the retina. Binocular enucleation was performed between embryonic days E60 and E81, prior to the ingrowth of geniculocortical fibers into the cortical plate and before genesis of the granular and supragranular layers of the visual cortex. The animals were delivered at term (E165) and sacrificed at 2 or 12 months of age, and their brains frozen and the occipital lobes cut at 20 microns in the coronal plane. Cortical binding of 3H-clonidine, 125I-pindolol, 3H-5-HT, 3H-ketanserin, 3H-spiperone, 3H-SCH23390, and 3H-prazosin that label various monoamine receptors were autoradiographically visualized and quantified using a computer imaging system. All radioligands displayed specific laminar patterns in the striate and prestriate areas in both groups of animals. The areal and laminar distribution in the anophthalmic monkeys was similar to that in the controls. Significantly, in all enucleated animals, just as in the controls, a particularly high density of 3H-clonidine and 3H-prazosin was observed in the sublayers of layer IV involved in color vision. The present results show that the monoamine receptors in primate visual cortex can establish and maintain distinct laminar and areal patterns in the absence of activity or molecular cues originated from the retina, and provide new insight into the cortical consequences of secondary congenital anophthalmia.

Phased-array surface coil MR of the orbits and optic nerves

PURPOSE

To devise a practical technique for high-resolution evaluation of the anterior optic apparatus using a phased-array surface coil system, and to evaluate this system in patients with suspected optic pathway abnormalities.

METHODS

A four-element phased-array coil pair was placed on each side of the head, and signal-to-noise measurements were obtained using a head phantom. Comparison between the phased-array coil, the quadrature coil, and a single-turn 12.7-cm (5-in) surface coil was done. T1 spin-echo and T2 fast spin-echo sequences were obtained in the oblique axial and oblique sagittal planes, to approximate the long axis of the optic nerves and the nonoblique coronal plane.

RESULTS

The phantom signal-to-noise measurements at simulated locations of the optic nerve head, optic canal, and optic chiasm revealed an improvement of at least 30% using the phased-array system. Of 24 imaged cases, 9 had trauma, 5 had suspected neoplasms, and 2 had optic neuritis. In 3 patients, an unexpected diagnosis of optic pathway contusion or infarction was made. The remaining 8 patients had various suspected visual pathway lesions.

CONCLUSION

Phased-array surface coils allow rapid, thin-section imaging of the entire anterior optic pathway, with improved signal-to-noise ratio. This may improve evaluation of optic pathway lesions over conventional techniques.

Pattern reversal visual evoked potentials in minor head injury

Pattern reversal visual evoked potentials (PR-VEPs) have been recorded in 50 patients with minor head injury (MHI) on days 1 and 30 after trauma and the data compared to 20 normals. None of the patients had visual complaints. The aim was to investigate a possible visual pathway affection in MHI and test the usefulness of PR-VEPs as an objective noninvasive tool in the detection of a possible subclinical affection of the visual system in MHI. P100 latency and amplitude had no significant difference compared to normals. Comparison of patient data on days 1 and 30 after trauma showed a significant latency decrease and amplitude increase on day 30, compared to day 1. These alterations were not age dependent. Our data suggest affection of the human visual pathway in MHI. PR-VEP recording seems to be a useful, objective, noninvasive tool, helping to identify possible subclinical affections of the visual pathway in MHI.