In monkeys and humans, two functionally specialized cortical streams of visual processing emanating from V1 have been proposed: a dorsal, action-related system and a ventral, perception-related pathway. Traditionally, a separate organization of the two streams is assumed; the extent of functional interaction is unknown. After lesions of the dorsal stream in patients with optic ataxia, it has recently been shown that the ventral perception-related system might contribute to visuomotor processing if movements rely on remembered target positions. The ventral pathway thus seemed to participate in goal-directed movements, a function that previously has been assigned exclusively to the dorsal stream. We wondered whether different types of pointing movements are controlled by switching between two separated cortical pathways or whether a variable interaction of interconnected systems should be assumed. Our study investigated two acute stroke patients with optic ataxia following lesions of the dorsal stream in a delayed pointing task. The delays ranged from 0 to 10 sec. The patients' pointing error decreased in a linear manner with the length of time. The finding suggests a gradual change between dorsal and ventral control of reaching behavior, rather than a sudden switch between two separated cortical processing streams. Although our observations with two patients require further validation, the results suggest that the ventral and dorsal systems interact closely in the sensorimotor control of reaching behavior.
Article abstract In patients with spatial neglect, contralesional reflexive saccades toward suddenly appearing targets show direction-specific deficits. We examined whether these deficits also occur during free exploration of space. Neglect patients' voluntary eye movements showed reduced amplitudes for saccades in all directions but no direction-specific deficit. The results argue against an interpretation of spatial neglect as a general deficit to disengage attention or to program saccades in contralesional direction.
The phenomenon of spatial neglect after right brain damage greatly helps our understanding of the normal mechanisms of directing and maintaining spatial attention, of spatial orientation, and the characteristics of neural representation of space. The intriguing symptom is a spontaneous orientation bias towards the right leading to neglect of objects or persons on the left. Interestingly, we observe similar symptoms namely a spontaneous bias of eyes and head along the horizontal dimension of space in patients with unilateral vestibular dysfunction. Further similarities concern anatomical findings. Both spatial neglect and vestibular processing at cortical level show dominance in the right hemisphere and involve common brain areas. Lesion studies in human and monkey, electrical and transcranial magnetic stimulation, as well as functional imaging results have revealed the superior temporal cortex, insula and the temporo-parietal junction to be substantial parts of the multisensory (vestibular) system as well as to be affected in spatial neglect. We argue that these structures are not strictly ‘vestibular’ but rather have a multimodal character representing a significant site for the neural transformation of converging vestibular, auditory, neck proprioceptive and visual input into higher order spatial representations. Neurons of these regions provide us with redundant information about the position and motion of our body in space. They seem to play an essential role in adjusting body position relative to external space. This view may initiate further development of those strategies to treat spatial neglect that use routes to rehabilitation based on specific manipulations of sensory input feeding into this system.
Spatial neglect is characterized by a deviation of the eyes and the head during active search, as well as at rest. Here the authors investigate the hitherto unknown relationship between these striking behaviors in the course of recovery. Gaze, eye-in-head, and head-on-trunk positions were recorded separately under two experimental conditions: (i) at rest (i.e., without any specific requirements, doing nothing) and (ii) during active exploratory search in a large visual array of 240 degrees x 80 degrees over a 10-month period. The authors observed a parallel decrease of eye and head (= gaze) deviation in both conditions, accompanied by a comparable decline in neglect severity. The results strengthen the view that the marked gaze deviation toward the ipsilesional side in patients with spatial neglect is due to a very elementary disturbance of human spatial information processing.
This scientific commentary refers to ‘Human brain lesion-deficit inference remapped’, by Y.-H. Mah et al. (doi: 10.1093/brain/awu164).
A cardinal goal in neuroscience relates to mapping brain circuits to specific functions. Although progress towards this goal has been made using a range of measurement techniques applicable in healthy human subjects, the brain circuits that are necessary for a given function can only be ascertained by observing the behavioural consequences of brain injury (Rorden and Karnath, 2004). In the evolution of this domain, voxel-wise lesion symptom mapping (VLSM; Bates et al. , 2003) represents a tremendous step forward. This statistical approach, as well as other inferential methods (e.g. Rorden et al. , 2007), controls for regions that are not critical for the behavioural deficit under consideration; i.e. VLSM rules out regions of the brain that are simply vulnerable to damage and thus commonly damaged in stroke patients.
However, a limitation of this mass univariate approach is that it typically does not consider how multiple regions interact to produce a behavioural deficit. Indeed, in cases where function is tied to a distributed network of regions, two patients with the same symptom and with damage to the same functional network may have damage to distinct parts of the network, thus appearing as statistical counter examples to each other [ cf . the ‘partial injury problem’ (Rorden and Karnath, 2004)]. To overcome this problem, Smith et al. (2013) used multivariate pattern analysis (MVPA) for lesion analysis, which uses machine learning algorithms (e.g. support vector machines) to train and then test predictive models based on the pattern of damage to multiple regions (Fig. 1). This seminal application of MVPA to lesion data addressed the multivariate patterns of damage predictive of spatial neglect. In a large sample of 140 patients with acute right brain damage, MVPA …
The human somatosensory cortex (S1) is not among the brain areas usually associated with visuospatial attention. However, such a function can be presumed, given the recently identified eye proprioceptive input to S1 and the established links between gaze and attention. Here we investigated a rare patient with a focal lesion of the right postcentral gyrus that interferes with the processing of eye proprioception without affecting the ability to locate visual objects relative to her body or to execute eye movements. As a behavioral measure of spatial attention, we recorded fixation time during visual search and reaction time for visual discrimination in lateral displays. In contrast to a group of age-matched controls, the patient showed a gradient in looking time and in visual sensitivity toward the midline. Because an attention bias in the opposite direction, toward the ipsilesional space, occurs in patients with spatial neglect, in a second study, we asked whether the incidental coinjury of S1 together with the neglect-typical perisylvian lesion leads to a milder neglect. A voxelwise lesion behavior mapping analysis of a group of right-hemisphere stroke patients supported this hypothesis. The effect of an isolated S1 lesion on visual exploration and visual sensitivity as well as the modulatory role of S1 in spatial neglect suggest a role of this area in visuospatial attention. We hypothesize that the proprioceptive gaze signal in S1, although playing only a minor role in locating visual objects relative to the body, affects the allocation of attention in the visual space.
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