Parnassia Psychiatric Institute, The Hague, the Netherlands; Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands; Department of Psychiatry, University of Groningen, Groningen, the Netherlands.
Department of Neurology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
Cortex. 2021 Jun;139:298-308. doi: 10.1016/j.cortex.2021.03.001. Epub 2021 Mar 12.
Prosopometamorphopsia is an extremely rare disorder of visual perception characterised by facial distortions. We here review 81 cases (eight new ones and 73 cases published over the past century) to shed light on the perception of face gestalts. Our analysis indicates that the brain systems underlying the perception of face gestalts have genuine network properties, in the sense that they are widely disseminated and built such that spatially normal perception of faces can be maintained even when large parts of the network are compromised. We found that bilateral facial distortions were primarily associated with right-sided and bilateral occipital lesions, and unilateral facial distortions with lesions ipsilateral to the distorted hemifield and with the splenium of the corpus callosum. We also found tentative evidence for the involvement of the left frontal regions in the fusing of vertical hemi-images of faces, and of right parietal regions in the fusing of horizontal hemi-images. Evidence supporting the remarkable adaptability of the network comes from the relatively high recovery rates that we found, from the ipsilateral hemifield predominance of hemi-prosopometamorphopsia, and from a phenomenon called cerebral asthenopia (heightened visual fatigability) which points to the dynamic nature of compensatory mechanisms maintaining normal face perception, even in chronic cases of prosopometamorphopsia. Finally, our analysis suggests that specialised networks for the representation of face gestalts in familiar-versus-unfamiliar faces and for own-versus-other face may be present, although this is in need of further study.
人面失认症是一种极其罕见的视觉感知障碍，其特征是面部扭曲。我们在这里回顾了 81 例病例（8 例新病例和过去一个世纪发表的 73 例病例），以阐明对面部整体感知的认识。我们的分析表明，对面部整体感知的大脑系统具有真正的网络特性，也就是说，它们分布广泛，构建方式使得即使网络的大部分受到损害，也能维持对面部的正常感知。我们发现，双侧面部扭曲主要与右侧和双侧枕叶病变有关，单侧面部扭曲与扭曲半视野同侧的病变以及胼胝体压部有关。我们还发现了左侧额叶区域在融合面部垂直半图像以及右侧顶叶区域在融合面部水平半图像中参与融合的初步证据。支持网络显著适应性的证据来自我们发现的相对较高的恢复率，来自同侧半视野对半面失认症的优势，以及一种称为脑疲劳（视觉疲劳加剧）的现象，这表明维持正常面部感知的补偿机制具有动态性，即使在慢性人面失认症病例中也是如此。最后，我们的分析表明，存在专门用于代表熟悉面孔与不熟悉面孔以及自己面孔与他人面孔的面部整体的网络，尽管这需要进一步研究。
