Noa Raz

Early 'visual' cortex activation correlates with superior verbal memory performance in the blind

The visual cortex may be more modifiable than previously considered. Using functional magnetic resonance imaging (fMRI) in ten congenitally blind human participants, we found robust occipital activation during a verbal-memory task (in the absence of any sensory input), as well as during verb generation and Braille reading. We also found evidence for reorganization and specialization of the occipital cortex, along the anterior–posterior axis. Whereas anterior regions showed preference for Braille, posterior regions (including V1) showed preference for verbal-memory and verb generation (which both require memory of verbal material). No such occipital activation was found in sighted subjects. This difference between the groups was mirrored by superior performance of the blind in various verbal-memory tasks. Moreover, the magnitude of V1 activation during the verbal-memory condition was highly correlated with the blind individuals abilities in a variety of verbal-memory tests, suggesting that the additional occipital activation may have a functional role.

Cortical activity during tactile exploration of objects in blind and sighted humans

PURPOSE Recent studies show evidence of multisensory representation in the functionally normal visual cortex, but this idea remains controversial. Occipital cortex activation is often claimed to be a reflection of mental visual imagery processes triggered by other modalities. However, if the occipital cortex is genuinely active during touch, this might be the basis for the massive cross-modal plasticity observed in the congenitally blind. METHODS To address these issues, we used fMRI to compare patterns of activation evoked by a tactile object recognition (TOR) task (right or left hand) in 8 sighted and 8 congenitally blind subjects, with several other control tasks. RESULTS TOR robustly activated object selective regions in the lateral occipital complex (LOC/LOtv) in the blind (similar to the patterns of activation found in the sighted), indicating that object identification per se (i.e. in the absence of visual imagery) is sufficient to evoke responses in the LOC/LOtv. Importantly, there was negligible occipital activation for hand movements (imitating object palpations) in the occipital cortex, in both groups. Moreover, in both groups, TOR activation in the LOC/LOtv was bilateral, regardless of the palpating hand (similar to the lack of strong visual field preference in the LOC/LOtv for viewed objects). Finally, the most prominent enhancement in TOR activation in the congenitally blind (compared to their sighted peers) was found in the posterior occipital cortex. CONCLUSIONS These findings suggest that visual imagery is not an obligatory condition for object activation in visual cortex. It also demonstrates the massive plasticity in visual cortex of the blind for tactile object recognition that involves both the ventral and dorsal occipital areas, probably to support the high demand for this function in the blind.

Axonal loss of retinal neurons in multiple sclerosis associated with optic radiation lesions

Objective: To investigate the potential links between thinning of retinal ganglion cell axons in eyes of patients with multiple sclerosis (MS) without past optic neuritis (ON) and MS-related inflammatory damage of the posterior visual pathway. Methods: Temporal retinal nerve fiber layer (tRNFL) thickness was analyzed in eyes with no history of ON (NON) from 53 patients with relapsing-remitting MS. Fifty normal age- and sex-matched controls were examined with optical coherence tomography. Low-contrast visual acuity charts were used for functional assessment of vision. The optic tract (OT) and optic radiation (OR) were identified using probabilistic tractography, and volume of T2 fluid-attenuated inversion recovery lesions and diffusion tensor imaging (DTI) indices were measured within both structures. Cross-sectional diameter of the OT was also calculated. Results: tRNFL thickness was significantly reduced in NON eyes and was associated with reduced low-contrast visual acuity. Lesions within the OR were detected in the majority of patients. There was a significant correlation between thinning of the tRNFL and OR lesion volume (adjusted for non-OR lesion volume, age, sex, and disease duration). tRNFL thickness also correlated with OR DTI indices. No OT lesions were identified in any of the patients and no relationship between retinal nerve fiber layer loss and potential markers of OT lesions was found. Conclusion: The results demonstrate a strong tract-specific association between loss of tRNFL fibers and MS-related inflammation within OR.

Demyelination affects temporal aspects of perception: An optic neuritis study

Visual Evoked Potentials (VEPs) following optic neuritis (ON) remain chronically prolonged, although standard visual tests indicate full recovery. We hypothesized that dynamic visual processes, such as motion perception, may be more vulnerable to slowed conduction in the optic nerve, and consequently be better associated with projection rates.

Sustained motion perception deficit following optic neuritis Behavioral and cortical evidence

Objective: To assess the recovery process in patients after an acute optic neuritis (ON) attack, comparing static and dynamic visual functions. Methods: In this prospective controlled study, 21 patients with unilateral, first-ever ON were followed over the course of 1 year. Standard visual tests, visual evoked potentials, and optical coherence tomography were assessed repeatedly. In addition, we developed a novel set of motion perceptual tasks to test dynamic visual deficits. fMRI examinations were performed to study the neuronal correlates for the behavioral findings. Results: Four months after the acute phase, the affected eyes had returned to normal performance levels in the routine visual testing. However, motion perception remained impaired throughout the 12-month period. In agreement with the clinical findings, fMRI studies showed recovery in cortical activation during static object recognition, as opposed to sustained deficit in tasks that require motion perception. Conclusions: Sustained motion perception deficit following ON may explain the continued visual complaints of patients long after recovery of visual acuity. Cortical activation patterns suggest that if plastic processes in higher visual regions contribute to the recovery of vision, this may be limited to static visual functions. Alternatively, cortical activation may reflect the visual percept (intact for visual acuity and impaired for motion perception), rather than demonstrating plastic processes. We suggest that motion perception should be included in the routine ophthalmologic tests following ON.

Temporal reorganization to overcome monocular demyelination

Objective: To identify the source of delayed visual evoked potential (VEP) latencies in the fellow eyes of patients with optic neuritis (ON) and determine whether these latencies stem from clinically silent demyelination or reflect an adaptive process for synchronization with the affected eyes. Methods: The study sample comprised 17 patients whom we followed for 12 to 26 months after unilateral first-ever ON diagnosis and 17 age-matched controls. To avoid confounding effects of axonal loss, only intact fellow eyes (except for VEPs) were included. Subjects underwent standard visual evaluation, motion perception, as well as static and time-constrained stereo tasks. Assessments included VEP, optical coherence tomography, high-resolution MRI, and diffusion tensor imaging. Results: We observed delayed VEP peaks (P100) in both affected and fellow eyes. However, while these were derived from prolonged time-to-start in the affected eyes, supporting the existence of demyelination, time-to-start in the fellow eyes was intact. VEP latencies in the fellow eyes could not be explained by demyelinative lesions along postchiasmal pathways (assessed by diffusion tensor imaging). Delayed peaks in fellow eyes resulted from a wider waveform, which evolved over time and occurred with a concomitant decrease in the gap in time between VEP peaks of both eyes. These changes offered a functional advantage; synchronization of inputs highly correlated with improved time-constrained binocular perception. Conclusion: Delayed latencies in the fellow eyes may reflect adaptive mechanisms at the cortical level that improve binocular integration over time to adjust for the damage incurred. These data provide a unique demonstration of temporal reorganization that compensates for delayed transmittal of visual information to the cortex.

An fMRI Investigation of the Cortical Network Underlying Detection and Categorization Abilities in Hemianopic Patients

The current study aims to investigate visual scene perception and its neuro-anatomical correlates for stimuli presented in the central visual field of patients with homonymous hemianopia, and thereby to assess the effect of a right or a left occipital lesion on brain reorganization. Fourteen healthy participants, three left brain damaged (LBD) patients with right homonymous hemianopia and five right brain damaged (RBD) patients with left homonymous hemianopia performed a visual detection task (i.e. “Is there an image on the screen?”) and a categorization task (i.e. “Is it an image of a highway or a city?”) during a block-designed functional magnetic resonance imaging recording session. Cerebral activity analyses of the posterior areas—the occipital lobe in particular—highlighted bi-hemispheric activation during the detection task but more lateralized, left occipital lobe activation during the categorization task in healthy participants. Conversely, in patients, the same network of activity was observed in both tasks. However, LBD patients showed a predominant activation in their right hemisphere (occipital lobe and posterior temporal areas) whereas RBD patients showed a more bilateral activation (in the occipital lobes). Overall, our preliminary findings suggest a specific pattern of cerebral activation depending on the task instruction in healthy participants and cerebral reorganization of the posterior areas following brain injury in hemianopic patients which could depend upon the side of the occipital lesion.

Focal demyelinative damage and neighboring white matter integrity: an optic neuritis study

Background: Neuronal loss following damage is often greater than expected from the severity of injury to the nerve itself. The visual pathways, which comprise a well-defined system, and optic neuritis (ON), which is usually a discrete event, make a fine model to study this phenomenon. Objective: Understand the effect of focal optic nerve demyelination on neighboring white matter. Methods: Diffusion tensor imaging and probabilistic tractography were used to identify and characterize the optic tracts and radiations of 17 ON and matched controls. Data were correlated with retinal nerve fiber layer (RNFL) thickness. Results: Patients’ optic tracts exhibited reduced axial diffusivity, which correlated with RNFL thickness values. Patients’ optic radiations demonstrated intact axial diffusivity but reduced fractional anisotropy and elevated radial diffusivity, which could be explained by intra-bundle lesions. No correlations were found between diffusivity measurements in patients’ optic tracts and radiations; or between RNFL thickness and optic radiations’ diffusivity. Conclusions: Following ON, chronic axonal loss develops distally in the optic tracts, demonstrating Wallerian degeneration. Degeneration did not proceed to the optic radiations, opposing anterograde trans-neuronal changes. DTI in ON provides fine in-vivo human model for studying histological abnormalities in normal appearing white matter, localized in close proximity to damaged bundle.

Cortical and white matter mapping in the visual system-more than meets the eye: on the importance of functional imaging to understand visual system pathologies

Information transmission within the visual system is highly organized with the ultimate goal of accomplishing higher-order, complex visuo-spatial and object identity processing. Perception is dependent on the intactness of the entire system and damage at each stage-in the eye itself, the visual pathways, or within cortical processing-might result in perception disturbance. Herein we will review several examples of lesions along the visual system, from the retina, via the optic nerve and chiasm and through the occipital cortex. We will address their clinical manifestation and their cortical substrate. The latter will be studied via functional magnetic resonance imaging (fMRI) and Diffusion Tensor Imaging (DTI), enabling cortical, and white matter mapping of the human brain. In contrast to traditional signal recording, these procedures enable simultaneous evaluation of the entire brain network engaged when subjects undertake a particular task or evaluate the entirety of associated white matter pathways. These examples provided will highlight the importance of using advanced imaging methods to better understand visual pathologies. We will argue that clinical manifestation cannot always be explained solely by structural damage and a functional view is required to understand the clinical symptom. In such cases we recommend using advanced imaging methods to better understand the neurological basis of visual phenomena.

Functional MRI as a tool for assessing chiasmal visual defect in a patient with neuromyelitis optica

Bitemporal haemianopsia is the classic visual field defect of disorders that involve the optic chiasm, caused by the involvement of the crossing nasal–retinal fibres of each optic nerve. Chiasmal visual field defects are usually categorised as extrinsic because of mechanical compression from adjacent structures, although lesions involving the substance of the chiasm itself also exist.1 We describe a unique case of chiasmal neuritis, a woman with serologically proven neuromyelitis optica (NMO).2 Our study addresses the cortical consequences of this acquired bitemporal haemianopsia. Functional MRI (fMRI) was used to evaluate the cortical activation patterns and its correspondence with visual field representation during the attack and subsequent recovery. A 36-year-old woman presented with acute bilateral visual loss progressing during several days before her admission. Her history included serologically positive myasthenia gravis at the age of 10 years, which required immunosuppressive treatment that led to clinical remission and cessation of all drug treatment at age 13 years. She was asymptomatic until age 26 years, when she presented with an episode of transverse myelitis. Since then, she has had another three severe myelitic episodes, without optic nerve involvement and was, therefore, under maintained treatment of prednisone and cyclophosphamide. Six months before her current admission, she was tested positive for NMO–immunoglobulin.2 To note is that her daily cyclophosphamide dosage was reduced just before her current admission. Her clinical examination revealed a parapyramidal syndrome with sensory level at T5 and mild left optic disc temporal pallor. No relative afferent pupillary defect was detected. Snellen visual acuity measurements were 6/60 …