Complementary deficits in perceptual classification in pure alexia and acquired prosopagnosia - New insights from two classic cases.

Pure alexia and prosopagnosia traditionally have been seen as prime examples of dissociated, category-specific agnosias affecting reading and face recognition, respectively. More recent accounts have moved towards domain-independent explanations that postulate potential cross-links between different types of visual agnosia. According to one proposal, abnormal crowding, i.e. the impairment of recognition when features of adjacent objects are positioned too closely to each other, might provide a unified account for the perceptual deficits experienced by an agnosic patient. An alternative approach is based on the notion of complementary visual subsystems favouring the processing of abstract categories and specific exemplars, respectively. To test predictions of these two approaches with regard to pure alexia and prosopagnosia, we present previously unpublished data on digit recognition and visual crowding from two in the neuropsychological literature extensively studied patients, KD and MT (e.g., Campbell et al., 1986; Landis and Regard, 1988; Rentschler et al., 1994). Patient MT, diagnosed with pure alexia, showed pronounced abnormal foveal crowding, whereas KD, diagnosed with prosopagnosia, did not. These results form a distinct double dissociation with the performance of the two patients in other perceptual classification tasks involving Gabor micropatterns and textures, as well as Glass patterns, which revealed a significantly greater impairment in KD relative to MT. Based on an analysis of the specific task demands we argue that prosopagnosia and pure alexia may involve complementary deficits in instantiation and abstraction, respectively, during perceptual classification, beyond any category specificity. Such an explanation appears in line with previous distinctions between a predominantly left-hemispheric, abstract-category and a predominantly right-hemispheric, specific-exemplar subsystem underlying object recognition.

Impaired visual search with paradoxically increased facilitation by emotional features after unilateral pulvinar damage.

Posterior thalamic pulvinar nuclei have been implicated in different aspects of spatial attention, but their exact role in humans remain unclear. Most neuropsychological studies of attention deficits after pulvinar lesion have concerned single patients or small samples. Here we examined a group of 13 patients with focal damage to posterior thalamus on a visual search task with faces, allowing us to test several hypotheses concerning pulvinar function in controlling attention to visually salient or emotionally significant stimuli. Our results identified two subgroups of thalamic patients with distinct patterns of attentional responsiveness to emotional and colour features in face targets. One group with lesions located in anterior and ventral portions of thalamus showed intact performance, with a normal facilitation of visual search for faces with emotional (fearful or happy) expressions on both side of space, similar to healthy controls. By contrast, a second group showed a slower and poorer detection of face targets, most severe for neutral faces, but with a paradoxically enhanced facilitation by both colour and emotional features. This second group had lesions centred on the pulvinar, involving mainly the dorso-medial sectors in patients showing enhanced effects of colour features, but extending to more dorso-lateral sectors in those with enhanced effects of emotional features. These findings reveal that pulvinar nuclei are not critical for orienting attention to emotionally or visually salient features, but instead provide new evidence in support of previous hypotheses suggesting an important role in controlling attention in visual scenes with distracting information.

Detection of Right-to-Left Cardiac Shunt in the Absence of Transcranial Acoustic Bone.

PURPOSE: Paradoxical thrombotic embolism via right-to-left cardiac shunt (RLS) is a risk factor of cryptogenic ischemic stroke. Transtemporal Doppler (TTD) is a valid method used in the detection of patent foramen ovale (PFO). Temporal acoustic bone windows are missing with increasing age and in some younger subjects. We studied prospectively whether Doppler ultrasound of the cervical arteries (submandibular internal carotid artery [ICA] and vertebral artery [VA]) is an alternative, when compared to TTD, in the detection and quantification of PFO. MATERIAL AND METHODS: A total of 94 patients with sufficient temporal bone windows suffering from recent ischemic stroke underwent TTD and ICA (n = 51) or TTD and VA (n = 43). After injection of microbubbles, the numbers of artificial high-intensity signals (HITS) were recorded at rest and after Valsalva maneuver. RESULTS: For 47 patients in the ICA group, an RLS was found at rest in 23 patients and after Valsalva in 28 patients. At rest, sensitivity was 100%, specificity 96%, positive predictive value (ppv) 95.6%, and negative predictive value (npv) 100%. After Valsalva, sensitivity was 100%, specificity 95%, ppv 96.4%, npv 100%. For 43 patients in the VA group an RLS was found at rest in 14 patients and after Valsalva in 19 patients. At rest, sensitivity was 71.4%, specificity 100%, ppv 100%, and npv 87.8%. After Valsalva, 94.4%, 96%, 94.4%, and 96%, respectively. Pearson's correlations of the number of HITS between TTD and ICA and between TTD and VA were highly significant. CONCLUSIONS: When transcranial acoustic bone windows are missing, Doppler ultrasound of the cervical submandibular ICA and VAs are valid screening methods to detect RLS due to a PFO.

Review: Tales from Both Sides of the Brain.

Our brain has two hemispheres that specialize in different jobs-the right side processes spatial and temporal information, and the left side controls speech and language. How these two sides come together to create one mind is explained by pioneering neuroscientist Michael Gazzaniga in his new book, Tales from Both Sides of the Brain : A Life in Neuroscience (Ecco/Harper Collins, 2015). Gazzaniga is director of the SAGE Center for the Study of the Mind at the University of California, Santa Barbara, and a Dana Alliance member.

"Crossed" somatoparaphrenia: an unusual new case and a review of the literature.

Somatoparaphrenia is a delusional misidentification and confabulation of body parts, usually arm or hand, opposite to a cerebral lesion, generally of the "minor" right hemisphere. There is some controversy concerning lesion site (fronto-parietal; parieto-temporal; posterior insula, additional subcortical nuclei) or necessary associated symptoms (hemiparesis/plegia, anosognosia, neglect, position sense deficit). We here present a patient who is unusual in many respects, that is: (1) he is a right-hander with somatoparaphrenia after a "dominant" left-hemisphere lesion associated with aphasia and ideo-motor apraxia, but also with right hemineglect. He thus has "crossed" somatoparaphrenia; (2) his delusional misidentification concerned the right leg and not the arm or hand; (3) he has no anosognosia; (4) his proprioception is disturbed for the leg only; and (5) the lesion site is very posterior, a left occipito-parietal haemorrhage without involvement of the frontal lobe or the posterior insula. We present this case together with the seven other cases of "crossed somatoparaphrenia" with and without aphasia we found since 1935 in the literature and discuss their relevance in relation to the above controversies.

Submillisecond unmasked subliminal visual stimuli evoke electrical brain responses.

Subliminal perception is strongly associated to the processing of meaningful or emotional information and has mostly been studied using visual masking. In this study, we used high density 256-channel EEG coupled with an liquid crystal display (LCD) tachistoscope to characterize the spatio-temporal dynamics of the brain response to visual checkerboard stimuli (Experiment 1) or blank stimuli (Experiment 2) presented without a mask for 1 ms (visible), 500 µs (partially visible), and 250 µs (subliminal) by applying time-wise, assumption-free nonparametric randomization statistics on the strength and on the topography of high-density scalp-recorded electric field. Stimulus visibility was assessed in a third separate behavioral experiment. Results revealed that unmasked checkerboards presented subliminally for 250 µs evoked weak but detectable visual evoked potential (VEP) responses. When the checkerboards were replaced by blank stimuli, there was no evidence for the presence of an evoked response anymore. Furthermore, the checkerboard VEPs were modulated topographically between 243 and 296 ms post-stimulus onset as a function of stimulus duration, indicative of the engagement of distinct configuration of active brain networks. A distributed electrical source analysis localized this modulation within the right superior parietal lobule near the precuneus. These results show the presence of a brain response to submillisecond unmasked subliminal visual stimuli independently of their emotional saliency or meaningfulness and opens an avenue for new investigations of subliminal stimulation without using visual masking.

Neurological and robot-controlled induction of an apparition.

Tales of ghosts, wraiths, and other apparitions have been reported in virtually all cultures. The strange sensation that somebody is nearby when no one is actually present and cannot be seen (feeling of a presence, FoP) is a fascinating feat of the human mind, and this apparition is often covered in the literature of divinity, occultism, and fiction. Although it is described by neurological and psychiatric patients and healthy individuals in different situations, it is not yet understood how the phenomenon is triggered by the brain. Here, we performed lesion analysis in neurological FoP patients, supported by an analysis of associated neurological deficits. Our data show that the FoP is an illusory own-body perception with well-defined characteristics that is associated with sensorimotor loss and caused by lesions in three distinct brain regions: temporoparietal, insular, and especially frontoparietal cortex. Based on these data and recent experimental advances of multisensory own-body illusions, we designed a master-slave robotic system that generated specific sensorimotor conflicts and enabled us to induce the FoP and related illusory own-body perceptions experimentally in normal participants. These data show that the illusion of feeling another person nearby is caused by misperceiving the source and identity of sensorimotor (tactile, proprioceptive, and motor) signals of one's own body. Our findings reveal the neural mechanisms of the FoP, highlight the subtle balance of brain mechanisms that generate the experience of "self" and "other," and advance the understanding of the brain mechanisms responsible for hallucinations in schizophrenia.

Very early processing of emotional words revealed in temporoparietal junctions of both hemispheres by EEG and TMS.

We investigate the contribution of both hemispheres in a lateralised lexical decision paradigm with emotional and neutral words in healthy volunteers. In a first experiment, high-density EEG analysis using source imaging methods revealed early specific participation of the temporoparietal junctions (TPJ) in both hemispheres for the detection of words. Then, in an event-related transcranial magnetic stimulation experiment with the same task, the disruption of left or right TPJ compared with a control stimulation over the vertex showed a slowing that is more pronounced when words are emotional and presented in the left visual field (LVF). This indicates that interference with both left and right TPJ results in impaired processing of words that were presented to the LVF. In addition, these results point to a specific cooperative contribution of the right hemisphere in the processing of words with emotional content compared with neutral words at very early stages. Results from the two experiments can be integrated in a brain-based spatiotemporal model of the early detection of written words.

Hemispheric specialization varies with EEG brain resting states and phase of menstrual cycle.

A growing body of behavioral studies has demonstrated that women's hemispheric specialization varies as a function of their menstrual cycle, with hemispheric specialization enhanced during their menstruation period. Our recent high-density electroencephalogram (EEG) study with lateralized emotional versus neutral words extended these behavioral results by showing that hemispheric specialization in men, but not in women under birth-control, depends upon specific EEG resting brain states at stimulus arrival, suggesting that hemispheric specialization may be pre-determined at the moment of the stimulus onset. To investigate whether EEG brain resting state for hemispheric specialization could vary as a function of the menstrual phase, we tested 12 right-handed healthy women over different phases of their menstrual cycle combining high-density EEG recordings and the same lateralized lexical decision paradigm with emotional versus neutral words. Results showed the presence of specific EEG resting brain states, associated with hemispheric specialization for emotional words, at the moment of the stimulus onset during the menstruation period only. These results suggest that the pre-stimulus EEG pattern influencing hemispheric specialization is modulated by the hormonal state.

An LCD tachistoscope with submillisecond precision.

Tachistoscopes allow brief visual stimulation delivery, which is crucial for experiments in which subliminal presentation is required. Up to now, tachistoscopes have had shortcomings with respect to timing accuracy, reliability, and flexibility of use. Here, we present a new and inexpensive two-channel tachistoscope that allows for exposure durations in the submillisecond range with an extremely high timing accuracy. The tachistoscope consists of two standard liquid-crystal display (LCD) monitors of the light-emitting diode (LED) backlight type, a semipermeable mirror, a mounting rack, and an experimental personal computer (PC). The monitors have been modified to provide external access to the LED backlights, which are controlled by the PC via the standard parallel port. Photodiode measurements confirmed reliable operation of the tachistoscope and revealed switching times of 3 µs. Our method may also be of great advantage in single-monitor setups, in which it allows for manipulating the stimulus timing with submillisecond precision in many experimental situations. Where this is not applicable, the monitor can be operated in standard mode by disabling the external backlight control instantaneously.

Can postictal memory predict postoperative memory in patients with temporal lobe epilepsy?

We investigated the contribution of postictal memory testing for lateralizing the epileptic focus and predicting memory outcome after surgery for temporal lobe epilepsy (TLE). Forty-five patients with TLE underwent interictal, postictal, and postoperative assessment of verbal and nonverbal memory. Surgery consisted of anterior temporal lobectomy (36), selective isolated amygdalohippocampectomy (6), or amygdalohippocampectomy coupled to lesionectomy (3). Postictal and postoperative but not interictal memory were significantly lower in left TLE than in right TLE. Nonverbal memory showed no significant difference in left TLE versus right TLE in all conditions. Postictal memory was significantly correlated with postoperative memory, but the effect disappeared when the lateralization of the focus was considered. Postictal verbal memory is a useful bedside tool that can help lateralize the epileptic focus. Larger studies are needed to further estimate its predictive value of the postoperative outcome.

Crossed ataxia: a case report and a diffusion tensor imaging tractography study.

BACKGROUND AND PURPOSE: Ever since the seminal description of ataxic hemiparesis contralateral to a pontine lesion by Miller-Fisher, the question of why contralesional crossing pontocerebellar fibers do not more frequently produce ipsilesional hemiataxia was raised. The few cases of "quadrataxic hemiparesis" or bilateral leg ataxia remain exceptions. SUMMARY OF CASE: We report an even more unusual variant, namely "crossed ataxia" of the contralesional arm and the ipsilesional leg subsequent to an anteromedial pontine ischemic stroke. CONCLUSIONS: MRI diffusion tensor imaging tractography shows that caudal contralesional crossing pontocerebellar fibers (those for the leg) travel trough the lesion, whereas more rostral fibers (those for the arm) are spared.

Simultaneous Doppelgänger and limb amputation impression in right frontal opercular stroke.

A case is described of a patient who presented almost simultaneously the impression that his left arm was amputated and the feeling of the presence of his invisible Doppelgänger. While these body scheme disorders have both been described after (right) parietal lesions, a right frontal opercular ischaemic stroke was found in the neurological work up. Diffusion tensor imaging showed that the stroke involved the ventral bundle of the superior longitudinal fasciculus that connects the parietal to the frontal lobe. The unusual clinical presentation of this frontal lesion may have been due to a 'diaschisis'-like phenomenon via the superior longitudinal fasciculus.

On the origin of the N400 effects: an ERP waveform and source localization analysis in three matching tasks.

The question of the cognitive nature and the cerebral origins of the event-related potential (ERP) N400 component has frequently been debated. Here, the N400 effects were analyzed in three tasks. In the semantic task, subjects decided whether sequentially presented word pairs were semantically related or unrelated. In the phonologic (rhyme detection) task, they decided if words were phonologically related or not. In the image categorization task, they decided whether images were categorically related or not. Difference waves between ERPs to unrelated and related conditions (defined here as the N400 effect) demonstrated a greater amplitude and an earlier peak latency effect in the image than in semantic and phonologic tasks. In contrast, spatial correlation analysis revealed that the maps computed during the peak of the N400 effects were highly correlated. Source localization computed from these maps showed the involvement in all tasks of the middle/superior temporal gyrus. Our results suggest that these qualitatively similar N400 effects index the same cognitive content despite differences in the representational formats (words vs. images) and the types of mismatch (semantic vs. phonological) across tasks.

The neural substrates and timing of top-down processes during coarse-to-fine categorization of visual scenes: a combined fMRI and ERP study.

Spatial frequencies in an image influence visual analysis across a distributed, hierarchically organized brain network. Low spatial frequency (LSF) information may rapidly reach high-order areas to allow an initial coarse parsing of the visual scene, which could then be "retroinjected" through feedback into lower level visual areas to guide finer analysis on the basis of high spatial frequency (HSF). To test this "coarse-to-fine" processing scheme and to identify its neural substrates in the human brain, we presented sequences of two spatial-frequency-filtered scenes in rapid succession (LSF followed by HSF or vice versa) during fMRI and ERPs in the same participants. We show that for low-to-high sequences (but not for high-to-low sequences), LSF produces a first increase of activity in prefrontal and temporo-parietal areas, followed by enhanced responses to HSF in primary visual cortex. This pattern is consistent with retroactive influences on low-level areas that process HSF after initial activation of higher order areas by LSF.

Reversed flow in the external carotid artery despite a patent but stenosed common carotid artery.

BACKGROUND AND PURPOSE: Occlusion of the common carotid artery (CCA) is generally associated with an occlusion of the ipsilateral internal carotid artery (ICA) or of the external carotid artery (ECA) or of both. Sometimes, collateral circulation to the ECA may preserve patency of the ICA via retrograde perfusion through the bulb. We herewith report a case of reversed flow in the ECA in the presence of a patent but stenosed CCA as diagnosed with color-coded duplex flow imaging (CDFI). CASE REPORT: This 85-year-old right-handed man was admitted for rapidly regressive acute dysarthria associated with left hemiparesis. Diffusion-weighted magnetic resonance (MR) imaging showed an acute ischemic lesion in the territory of the right middle cerebral artery. MR angiography showed patency of the right ICA and ECA but an occlusion of the CCA was suspected. CDFI demonstrated patency of the right CCA with a high-resistance pattern due to a large, partially calcified, stenosing atheromatous plaque. Surprisingly, reversed flow was observed in the right ECA of which signal was dampened. CONCLUSION: Collateralization with reversed flow in the ECA may occur in a patent but stenosed CCA associated with a high-grade stenosis of the carotid bifurcation. CDFI is a very useful tool to detect such hemodynamic conditions.

Electrical neuroimaging of single trials to identify laterality and brain regions involved in finger movements.

Thought-controlled neuroprostheses could allow paralyzed patients to interact with the external world using brain waves. Thus far, the fastest and more accurate control of neuroprostheses is achieved through direct recordings of neural activity [Nicolelis, M.A., 2001. Actions from thoughts. Nature 409, 403-407; Donoghue, J.P., 2002. Connecting cortex to machines: recent advances in brain interfaces. Nat. Neurosci. 5 (Suppl.), 1085-1088]. However, invasive recordings have inherent medical risks. Here we discuss some approaches that could enhance the speed and accuracy of non-invasive devices, namely, (1) enlarging the spectral analysis to include higher frequency oscillations, able to transmit substantial information over short analysis windows; (2) using spectral analysis procedures that minimize the variance of the estimates; and (3) transforming EEG recorded activity into local field potential estimates (eLFP). Theoretical and experimental arguments are used to explain why it is erroneous to think that scalp EEG cannot sense high frequency oscillations and how this might hinders further developments. We further illustrate how non-invasive eLFPs derived from the scalp-recorded electroencephalogram (EEG) can be combined with robust, broad band spectral analysis to accurately detect (off-line) the laterality of upcoming hand movements. Interestingly, the use of pattern recognition to select the brain voxels differentially engaged by the explored tasks leads to sound neural activation images. Consequently, our results indicate that both research lines, i.e., neuroprosthetics and electrical neuroimaging, might effectively benefit from their mutual interaction.