Robotham Ro Julia, Rice Grace E, Leff Alex P, Lambon Ralph Matthew A, Starrfelt Randi
Department of Psychology, University of Copenhagen, Copenhagen 1353, Denmark.
MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK.
Brain Commun. 2023 Feb 28;5(2):fcad050. doi: 10.1093/braincomms/fcad050. eCollection 2023.
Knowledge about the consequences of stroke on high-level vision comes primarily from single case studies of patients selected based on their behavioural profiles, typically patients with specific stroke syndromes like pure alexia or prosopagnosia. There are, however, no systematic, detailed, large-scale evaluations of the more typical clinical behavioural and lesion profiles of impairments in high-level vision after posterior cerebral artery stroke. We present behavioural and lesion data from the Back of the Brain project, to date the largest ( = 64) and most detailed examination of patients with cortical posterior cerebral artery strokes selected based on lesion location. The aim of the current study was to relate behavioural performance with faces, objects and written words to lesion data through two complementary analyses: (i) a multivariate multiple regression analysis to establish the relationships between lesion volume, lesion laterality and the presence of a bilateral lesion with performance and (ii) a voxel-based correlational methodology analysis to establish whether there are distinct or separate regions within the posterior cerebral artery territory that underpin the visual processing of words, faces and objects. Behaviourally, most patients showed more general deficits in high-level vision ( = 22) or no deficits at all ( = 21). Category-selective deficits were rare ( = 6) and were only found for words. Overall, total lesion volume was most strongly related to performance across all three domains. While behavioural impairments in all domains were observed following unilateral left and right as well as bilateral lesions, the regions most strongly related to performance mainly confirmed the pattern reported in more selective cases. For words, these included a left hemisphere cluster extending from the occipital pole along the fusiform and lingual gyri; for objects, bilateral clusters which overlapped with the word cluster in the left occipital lobe. Face performance mainly correlated with a right hemisphere cluster within the white matter, partly overlapping with the object cluster. While the findings provide partial support for the relative laterality of posterior brain regions supporting reading and face processing, the results also suggest that both hemispheres are involved in the visual processing of faces, words and objects.
关于中风对高级视觉影响的知识主要来自基于行为特征挑选出的患者的单病例研究，这些患者通常患有特定的中风综合征，如纯失读症或面孔失认症。然而，目前尚无对大脑后动脉中风后高级视觉损伤的更典型临床行为和病变特征进行系统、详细、大规模的评估。我们展示了“大脑后部”项目的行为和病变数据，该项目是迄今为止对基于病变位置挑选出的大脑后动脉皮质中风患者进行的规模最大（=64例）、最详细的检查。本研究的目的是通过两种互补分析，将对面孔、物体和书面文字的行为表现与病变数据联系起来：（i）多变量多元回归分析，以确定病变体积、病变侧别和双侧病变的存在与表现之间的关系；（ii）基于体素的相关方法分析，以确定大脑后动脉区域内是否存在支持单词、面孔和物体视觉处理的不同或独立区域。在行为方面，大多数患者在高级视觉方面表现出更普遍的缺陷（=22例）或根本没有缺陷（=21例）。类别选择性缺陷很少见（=6例），且仅在单词方面出现。总体而言，总病变体积与所有三个领域的表现最密切相关。虽然单侧左、右以及双侧病变后均观察到所有领域的行为损伤，但与表现最密切相关的区域主要证实了在更具选择性的病例中报告的模式。对于单词，这些区域包括从枕极沿梭状回和舌回延伸的左半球簇；对于物体，双侧簇与左枕叶的单词簇重叠。面孔表现主要与白质内的右半球簇相关，部分与物体簇重叠。虽然这些发现为支持阅读和面孔处理的大脑后部区域的相对侧别提供了部分支持，但结果也表明两个半球都参与了面孔、单词和物体的视觉处理。
