Visual Cortex In Patients Research Articles

Sensitization of the Visual Cortex in Patients with Chronic Migraine: a Magnetoencephalographic Study

Sensitization of the Visual Cortex in Patients with Chronic Migraine: a Magnetoencephalographic Study

The Organization of the Visual Cortex in Patients with Scotomata Resulting from Lesions of the Central Retina

Primary visual cortex can undergo forms of reorganization following bilateral lesions to the retinas of animals. Brain cells that originally received input from retinal tissue that was lesioned become responsive to retina that remains intact. In humans, reorganization of the primary visual cortex has been found in adult patients with congenital foveal lesions. More recent investigations of patients with macular degeneration, who acquired retinal lesions later, have yielded mixed results. In this paper we review the evidence for and characteristics of cortical reorganization in humans and animals and suggest how it might be evaluated in the context of strategies for treating retinal disease.

Visual Evoked Potentials

ABSTRACT.Pattern reversal evoked potentials (PVEPs) are a noninvasive procedure that are useful for detecting lesions of the visual pathways. This article reviews anatomy of the visual pathway and the testing protocols for full field and hemifield PVEP and flash (goggle) visual evoked potentials (FVEP). Criteria for evaluation of normal and abnormal responses and clinical correlates are discussed. We conclude with a brief discussion of recording visual evoked potentials (VEPs) from subdural or depth electrodes to localize primary visual cortex in patients, with a parieto-occipital seizure focus, who are undergoing evaluation for epilepsy surgery.

Selective magnetization transfer ratio decrease in the visual cortex following optic neuritis

Patients with clinically isolated syndromes suggestive of multiple sclerosis have evidence for abnormality in normal appearing grey matter detected using the magnetization transfer ratio (MTR), a quantitative MRI measure. One potential mechanism for the decreased grey matter MTR (GM MTR) observed is trans-synaptic morphological abnormality secondary to demyelinating lesions that are in an anatomically linked pathway but remote location. We investigated this potential association by studying the location of abnormalities using voxel-based analysis of GM MTR maps in a group of 80 patients studied within 6 months of presenting with isolated optic neuritis and compared the findings with those seen in 50 age- and sex-matched healthy controls. Occipital cortex and whole brain analysis comparing all optic neuritis patients and controls revealed a selective decrease of MTR bilaterally in the visual cortex in patients [Brodmann area (BA) 17]. Whole brain analysis of patients fulfilling the McDonald criteria for multiple sclerosis (n = 20) showed a lower MTR compared to controls bilaterally in the visual cortex (BA 17/18), left hippocampus, bilateral superior temporal gyrus, bilateral lenticular nuclei and the right cerebellum. There was no significant difference in the percentage of grey matter between patients and controls in the regions of abnormal MTR detected in the visual cortex. The intrinsic MTR decrease seen in patients suggests that there are structural changes in the visual cortex following an attack of optic neuritis. Potential mechanisms for this include trans-synaptic neuronal degeneration and cortical synaptic morphological changes; such abnormalities may also contribute to MTR abnormalities observed in the normal appearing grey matter in multiple sclerosis.

Three-month change in cerebral glucose metabolism in patients with nonarteritic ischemic optic neuropathy

No specific therapy is available for non-arteritic ischemic optic neuropathy (NAION), a blinding disease, which is related to microvascular insufficiency of the optic disc and white matter lesions in brain MRI representing ischemia. We hypothesize that pentoxifylline, traditionally used for treatment of peripheral vascular disease due to its ability to decrease viscosity and increase erythrocyte flexibility, may be useful to improve blood flow in patients with NAION. Positron emission tomography (PET) to determine the change in glucose metabolic rate in the visual cortex of patients with NAION versus age-matched controls was performed after 3 months' administration of pentoxifylline. Eight patients clinically diagnosed with NAION underwent clinical and laboratory evaluation, brain MRI and PET with fluoride-18 fluorodeoxyglucose (FDG). All patients were treated with oral pentoxifylline 400 mg three times a day for a period of at least 3 months. Three patients were included in the final PET data analysis. At baseline, PET revealed bilateral metabolic decreases especially in the ventral visual stream in all patients compared with 56 age- and gender-normalized controls. Metabolic changes were seen in the dorsal stream areas 17, 18, and 19, cerebellar region, dorsolateral prefrontal cortex, medial temporal lobe, and frontal eye fields 8 and 6. At 3 months following pentoxifylline, all three patients included in the final PET data analysis showed partial normalization from the baseline metabolism. Metabolic imaging with FDG-PET in NAION provides functional information not attainable with conventional brain MRI. The exact relevance of these results, and the role of pentoxifylline in these metabolic changes, should be determined by means of a larger randomized and controlled trial.

Lateral interactions in the visual cortex of patients with schizophrenia and bipolar disorder

Schizophrenia is associated with perceptual organization deficits and abnormal neuronal connectivity has been described in early visual areas. The purpose of this study was to investigate the functional integrity of lateral connections in early visual areas of patients with schizophrenia and type I bipolar disorder with a history of psychosis. Twenty-four out-patients with schizophrenia, 22 out-patients with bipolar disorder, and 20 healthy control subjects participated in the study. Using a computer-assisted psychophysical test, contrast thresholds were measured for centrally presented target stimuli (Gabor patches), which were surrounded by two collinear flankers. Target-to-flanker distances were 0, 1, 2, 3, 4, 6, 9 and 122. Psychophysical measures were contrast threshold changes at each target-to-flanker distance compared with baseline thresholds determined for isolated targets with no flankers. Clinical measures included IQ, positive, negative, and depressive symptoms. Results. In patients with schizophrenia, flankers did not facilitate contrast detection for target stimuli at 2-6 lambda distances compared to controls [effect size (Cohen's d): 1.25-1.42]. The inhibitory effect of flankers (0 and 1lambda) and contrast thresholds in the absence of flankers were spared. Patients with bipolar disorder did not differ from the controls. Medicated and non-medicated patients displayed similar performances. Positive and negative symptoms and depression did not correlate with contrast threshold values. Excitatory lateral connections in early visual cortex are specifically impaired in patients with schizophrenia, which may contribute to perceptual disorders such as unclear seeing, partial or skewed sight, disrupted rectilinearity, and abnormal figure-ground segregation.

Occipital Hypometabolism Demonstrated by Positron Emission Tomography After Temporal Lobectomy for Refractory Epilepsy

Epilepsy surgery involves well-planned discrete injury to the brain and may create visual deficits. This study seeks to evaluate the indirect effects of temporal lobectomy on brain metabolism by correlating visual field defects and glucose metabolism in the visual cortex of patients before and after undergoing epilepsy surgery. A retrospective survey of 11 patients who had undergone temporal lobectomy for refractory epilepsy in a single institution from 1986 to 1989, and who had pre-lobectomy and post-lobectomy visual field examinations and F-18 2-fluorodeoxyglucose positron emission tomography (FDG-PET) as part of a standard comprehensive epilepsy surgery evaluation. The PET images were analyzed to provide a correlation with the visual field defects that developed after the temporal lobectomy. Occipital hypometabolism in the absence of structural lesions of the occipital lobe was noted in seven patients with contralateral visual field defects and in one of four patients without a visual field defect. FDG-PET studies in three patients repeated for as long as 20 months after lobectomy showed no significant change in the occipital hypometabolism pattern. Although the occipital cortex was not directly injured during temporal lobectomy, the resulting hypometabolism correlates with the clinical findings of visual field defects. The hypometabolism may be due to deafferentation after interruption of the optic pathways and appears to be persistent.

Functional magnetic resonance imaging of the visual system.

Functional magnetic resonance imaging (fMRI), which is a technique useful for non-invasive mapping of brain function, is well suited for studying the visual system. This review highlights current clinical applications and research studies involving patients with visual deficits. Relevant reports regarding the investigation of the brain's role in visual processing and some newer fMRI techniques are also reviewed. Functional magnetic resonance imaging has been used for presurgical mapping of visual cortex in patients with brain lesions and for studying patients with amblyopia, optic neuritis, and residual vision in homonymous hemianopia. Retinotopic borders, motion processing, and visual attention have been the topics of several fMRI studies. These reports suggest that fMRI can be useful in clinical and research studies in patients with visual deficits.

Impaired activation of oxygen consumption and blood flow in visual cortex of patients with mitochondrial encephalomyopathy

A current hypothesis claims that an increase of blood flow is required for oxygen consumption to rise during neuronal excitation (activation). Chronic progressive external ophthalmoplegia is a mitochondrial disease associated with deletions of mtDNA or by point mutation of tRNA genes. We tested the hypothesis that the cerebral metabolic rate of oxygen (CMRO2) may not rise in this disorder if the accompanying cerebral blood flow increase is insufficient. Two patients with progressive external ophthalmoplegia were visually stimulated with a colored checkerboard pattern reversing as different frequencies. When stimulated, Patient 1 had a small increase of cerebral blood flow, while Patient 2 had no cerebral blood flow increase. In the visually active state, the patients had no significant change of CMRO2, while healthy subjects had a pronounced increase of CMRO2 in the pericalcarine visual cortex at 4 Hz and a further slight increase at 8 Hz during activation. Ann Neurol 2000;48:676–679

Impaired activation of oxygen consumption and blood flow in visual cortex of patients with mitochondrial encephalomyopathy

A current hypothesis claims that an increase of blood flow is required for oxygen consumption to rise during neuronal excitation (activation). Chronic progressive external ophthalmoplegia is a mitochondrial disease associated with deletions of mtDNA or by point mutation of tRNA genes. We tested the hypothesis that the cerebral metabolic rate of oxygen (CMRO2) may not rise in this disorder if the accompanying cerebral blood flow increase is insufficient. Two patients with progressive external ophthalmoplegia were visually stimulated with a colored checkerboard pattern reversing as different frequencies. When stimulated, Patient 1 had a small increase of cerebral blood flow, while Patient 2 had no cerebral blood flow increase. In the visually active state, the patients had no significant change of CMRO2, while healthy subjects had a pronounced increase of CMRO2 in the pericalcarine visual cortex at 4 Hz and a further slight increase at 8 Hz during activation.

Mitochondrial encephalomyopathy

We used localized H-magnetic resonance spectroscopy (MRS) to study the metabolic changes in the visual cortex of patients with mitochondrial encephalomyopathy. Measurement of metabolite levels in the occipital visual cortex obtained in the dark with seven normal subjects and with four patients (all four of whom had Kearns-Sayre syndrome [KSS]) showed high lactate levels in the patients. Photic stimulation (PS) in four normal volunteers showed that lactate increased immediately after the start of PS and that it decreased to the baseline level with continued PS. Lactate in the resting state was higher in the KSS patients than in the controls, and, unlike the controls, the KSS patients showed no significant elevation of lactate with PS.

Dendrites, dementia and the down syndrome

Findings from a Golgi study of the visual cortex in patients with the Down syndrome were compared with those from neurologically normal, age-matched control subjects. The dendritic atrophy seen in childhood continued into adulthood, with a marked decrease in dendritic branching, dendritic length, and spine frequency in elderly adults with the Down syndrome. Subject more than 30 years old occasionally had degenerating pyramidal neurons in the cerebral cortex and degenerated pyramidal neurons and aspiny stellate cells, particularly in the temporal cortex. These dendritic abnormalities may be related to mental retardation in children and early dementia in older adults who have the Down syndrome. The genetic and extrinsic factors may be important determinants of Alzheimer type dementia in the Down syndrome.