Compensatory eye and head movements of patients with homonymous hemianopia in the naturalistic setting of a driving simulation.

Homonymous hemianopia (HH) is a frequent deficit resulting from lesions to post-chiasmal brain structures with a significant negative impact on activities of daily living. To address the question how patients with HH may compensate their visual field defect in a naturalistic environment, we performed a driving simulation experiment and quantitatively analyzed both eye and head movements using a head-mounted pupil camera. 14 patients with HH and 14 matched healthy control subjects participated in the study. Based on the detection performance of dynamically moving obstacles, which appeared unexpectedly along the sides of the road track, we divided the patient group into a high- and a low-performance group. Then, we compared parameters of eye and head movements between the two patient groups and the matched healthy control group to identify those which mediate successful detection of potentially hazardous objects. Differences in detection rates could not be explained by demographic variables or the extent of the visual field defect. Instead, high performance of patients with HH in the naturalistic setting of our driving simulation depended on an adapted visual exploratory behavior characterized by a relative increase in the amplitude and a corresponding increase in the peak velocity of saccades, widening horizontally the distribution of eye movements, and by a shift of the overall distribution of saccades into the blind hemifield. The result of the group comparison analyses was confirmed by a subsequent stepwise regression analysis which identified the horizontal spread of eye movements as single factor predicting the detection of hazardous objects.

Severe cognitive impairment associated with intrathecal antibodies to the NR1 subunit of the N-methyl-D-aspartate receptor in a patient with multiple sclerosis.

IMPORTANCE: Some patients with multiple sclerosis (MS) can either present with or develop severe cognitive impairment during the course of their disease. However, the mechanisms underlying severe cognitive dysfunction in MS are not well understood. OBSERVATIONS: We report on a woman who was diagnosed as having MS at age 33 years and who after giving birth at age 37 years developed cognitive impairment with severe memory dysfunction as the leading symptom. Treatment with different immunotherapies, including cyclophosphamide and natalizumab, did not improve her cognitive deficits, necessitating admission to a nursing home at age 39 years. During a thorough reevaluation at age 43 years, analysis of current and stored cerebrospinal fluid and serum samples demonstrated an intrathecal synthesis of IgG antibodies to the NR1 subunit of the N-methyl-D-aspartate receptor, that is, the characteristic laboratory finding of anti-N-methyl-D-aspartate receptor encephalitis. Although the patient initially stabilized under therapy with corticosteroids, plasma exchange, and mitoxantrone, severe cognitive impairment persisted and she eventually died from the sequelae of her disease. CONCLUSIONS AND RELEVANCE: This report suggests that the occasional occurrence of severe cognitive impairment in patients with MS may, in some cases, be related to a superimposed antibody-mediated autoimmune encephalitis.

Neurological and neuropsychological characteristics of occipital, occipito-temporal and occipito-parietal infarction.

Neuropsychological deficits after occipital infarction are most often described in case studies and only a small sample of studies has attempted to exactly correlate the anatomical localization of lesions with associated neuropsychological symptoms. The present study investigated a large number of patients (N = 128) in order to provide an overview of neurological and neuropsychological deficits after occipital, occipito-temporal and occipito-parietal infarction. A particular approach of the study was to define exact anatomical correlates of neuropsychological dysfunction by using voxel-based lesion-symptom mapping (VLSM) in 61 patients. In addition to a visual field defect and phosphenes, patients often reported anomia, difficulties in reading and memory deficits. Visual disorders, such as achromatopsia, akinetopsia or prosopagnosia, were rarely reported by the patients. Memory and visual disorders were diagnosed efficiently using simple clinical screening tests, such as the Rey-Osterrieth Complex Figure Test for immediate recall, the Demtect and the Lang Stereo Test. Visual field defects, reading disorders and the perception of phosphenes were associated primarily with lesions of the calcarine sulcus. Anomia and memory deficits were related to lesions of the occipital inferior gyrus, the lingual gyrus and hippocampus, as well as to lesions of principal white matter tracts.

The role of the fusiform-amygdala system in the pathophysiology of autism.

CONTEXT: Autism is a condition of unknown origin with well-documented impairments in social perception and cognition. OBJECTIVE: To assess the relevance of the fusiform-amygdala system to the pathophysiology of autism spectrum conditions. DESIGN: Cross-sectional case-control study. SETTING: University hospital. PARTICIPANTS: A total of 27 adults with autism spectrum conditions and 29 age-, sex-, and intelligence quotient-matched typically developed healthy controls. Patients were assessed according to DSM-IV criteria using the Autism Diagnostic Interview-Revised. INTERVENTIONS: We applied an automated measurement to estimate fusiform gyrus cortical thickness and a manual tracing method to obtain amygdala volumes. We analyzed volumetric covariance among these brain regions and assessed the functional relevance of anatomical findings by analyzing correlations with emotional face-processing performance. MAIN OUTCOME MEASURES: Fusiform gyrus cortical thickness, amygdala volume, emotional face processing. RESULTS: We found a specific local increase in cortical thickness of the fusiform gyrus and associated impairments in face processing in individuals with autism. Anatomical covariance between amygdala volume and the increase in fusiform gyrus local thickness was significantly smaller in the group with autism spectrum conditions. CONCLUSIONS: Our data provide the first anatomical evidence of an abnormal amygdala-fusiform system and its behavioral relevance to face-processing deficits in autism spectrum conditions. In light of recent evidence of the involvement of the fusiform gyrus and amygdala in social perception as well as the areas of social cognition and emotional awareness, all of which are relevant to autism, our findings might represent a core pathophysiological mechanism of autism.

Sociotopy in the temporoparietal cortex: common versus distinct processes.

A major controversy in the social cognitive neurosciences evolved around the question whether activity in the posterior superior temporal sulcus and adjacent temporoparietal junction (pSTS/TPJ-region) evoked by various tasks represents a common process or distinct processes. To investigate this question, we employed functional magnetic resonance imaging (fMRI) while participants performed Biological Motion (BM), Theory-of-Mind (ToM) and Moral Judgment (MJ) tasks. Importantly, for each task we used the same newly developed animated stimuli. Indicative of a common process, we identified small clusters of overlapping activity for BM and ToM in right pSTS and for ToM and MJ in bilateral pSTS and left TPJ. Indicative of distinct processes, on the contrary, we detected extensive dissociable activity for BM in right pSTS, for ToM in bilateral pSTS and left TPJ, and for MJ in bilateral pSTS and TPJ. Thus, our data provide strong evidence for a combined two-staged process account: (i) the parsing of a stream of visual-spatial information, represented by activity in right pSTS, where neighboring and overlapping clusters of increased responses were found for all three tasks; (ii) increasingly more complex processing of the communicative significance of other people's behavior, represented by hierarchically increasing activity in left pSTS and bilateral TPJ elicited by ToM and MJ.

Dissociation of cognitive and emotional empathy in adults with Asperger syndrome using the Multifaceted Empathy Test (MET).

Empathy is a multidimensional construct consisting of cognitive (inferring mental states) and emotional (empathic concern) components. Despite a paucity of research, individuals on the autism spectrum are generally believed to lack empathy. In the current study we used a new, photo-based measure, the Multifaceted Empathy Test (MET), to assess empathy multidimensionally in a group of 17 individuals with Asperger syndrome (AS) and 18 well-matched controls. Results suggested that while individuals with AS are impaired in cognitive empathy, they do not differ from controls in emotional empathy. Level of general emotional arousability and socially desirable answer tendencies did not differ between groups. Internal consistency of the MET's scales ranged from .71 to .92, and convergent and divergent validity were highly satisfactory.