Pure alexia and word-meaning deafness in a patient with multiple sclerosis

OBJECTIVE: To describe pure alexia and auditory comprehension problems in a young woman with multiple sclerosis (MS). PATIENT: A 33-year-old woman with MS who complained of difficulties in reading and comprehending spoken language was referred for a neuropsychological examination. Reading difficulties were confirmed and most of the reading errors were additions, omissions, and substitutions of single letters. While the patient reported that the letters seemed to disappear before her eyes, no general problems with visual attention, visual discrimination, or scanning were detected. No difficulties with spelling were reported. The auditory comprehension deficit is interpreted as a form of a semantic access disorder and is not due to generalized slowing in information processing or conceptual disintegration. CONCLUSIONS: Pure alexia is unusual in MS and to our knowledge only 1 other case has been reported (in Japanese). Memory impairments and slowed information processing are probably the most frequent cognitive sequelae of the disease and, consequently, the literature is biased toward the study of those cognitive domains. However, given the wide distribution of sclerotic plaques in MS, it could be argued that we should expect some variability of cognitive changes in MS. Striking deficits as seen in this patient should make us more sensitive to this possibility.     

Theoretical analysis of the cognitive processing of lexical and pictorial stimuli: Reading, naming, and visual and conceptual comparisons.

This article reviews the research literature on the differences between word reading and picture naming. A theory for the visual and cognitive processing of pictures and words is then introduced. The theory accounts for slower naming of pictures than reading of words. Reading aloud involves a fast, grapheme-to-phoneme transformation process, whereas picture naming involves two additional processes; (a) determining the meaning of the pictorial stimulus and (b) finding a name for the pictorial stimulus. We conducted a reading-naming experiment, and the time to achieve (a) and (b) was determined to be approximately 160 ms. On the basis of data from a second experiment, we demonstrated that there is no significant difference in time to visually compare two pictures or two words when size of the stimuli is equated. There is no difference in time to make the two types of cross-modality conceptual comparisons (picture first, then word, or word first, then picture). The symmetry of the visual and conceptual comparison results supports the hypothesis that the coding of the mind is neither intrinsically linguistic nor imagistic, but rather it is abstract. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Associative visual agnosia resulting from a disconnection between intact visual memory and semantic systems

We report the case of a patient (RC) who developed a severe visual agnosia, associated to alexia without agraphia, color anomia and amnesia, following an ischemic stroke in the territory supplied by the left posterior cerebral artery. Based on his proficient performance on tests evaluating analysis of elementary visual features, formation of viewer-centered and object-centered representations of visual stimuli and discrimination between drawings representing real and unreal objects, we concluded that the critical locus of deficit was a disconnection between the normally functioning visual memory store and the semantic system. RC's disturbance in visual processing of human faces paralleled his recognition disorder of other classes of objects. The possible contribution of neurobiological factors in determining RC's agnosic deficit is discussed.     

Crohn''s disease in infancy: a case report

We present a patient with pure alexia following a hemorrhagic infarction in the left fusiform gyrus. The symptom began with alexia preferentially disturbed for kana, but during the course of recovery slight agraphia for kanji became pronounced. In the earlier phase, alexia was more severe than agraphia and he could write kanji that he could not read. Furthermore, kinesthetic reading was effective. These findings are consistent with the symptoms of pure alexia, although the fact that a writing disturbance for kanji persisted resembles the profile of alexia with agraphia for kanji due to a posterior inferior temporal lesion. Based on the fact that the posterior inferior temporal lesion showed more severe agraphic symptom and more frequent nonresponse writing errors of kanji, and that our patient's lesion was mainly located in the fusiform gyrus that is medial to the inferior temporal gyrus, we believe that alexia occurred when the inferior temporal gyrus was disconnected from the fusiform gyrus, as a result, visual information could not reach the inferior temporal gyrus in which the visual images of individual kanji are stored.     

Gonadotropins and glucocorticoid therapy for "low responders"--a controlled study

Traditional views of pure alexia have held that the disorder results from a disconnection between the secondary visual cortices of both hemispheres and the angular gyrus of the dominant hemisphere. Evidence has accumulated, however, suggesting the importance of the posterior inferior temporal area in visual language processing. We describe clinical-pathological support for the presence of a lateralized visual language association area residing in the dominant posterior inferior temporal lobe.     

Perirhinal cortex ablation impairs visual object identification

Impairments in both recognition memory and concurrent discrimination learning have been shown to follow perirhinal cortex ablation in the monkey. The pattern of these impairments is consistent with the hypothesis that the perirhinal cortex has a role in the visual identification of objects. In this study we compared the performance of a group of three cynomolgus monkeys with bilateral perirhinal cortex ablation with that of a group of three normal controls in two tasks designed to test this hypothesis more directly. In experiment 1 the subjects relearned a set of 40 familiar concurrent discrimination problems; the stimuli in each trial were digitized images of real objects presented in one of three different views. After attaining criterion they were tested on the same problems using similar, but previously unseen, views of the objects. In experiment 2 the subjects were tested on their ability to perform 10 of these familiar discriminations with each problem presented in the unfamiliar context of a digitized image of a unique complex scene. The subjects with ablations were significantly impaired on both tasks. These results demonstrate that the role of the perirhinal cortex is not restricted to memory, and they support the hypothesis that the perirhinal cortex is involved in visual object identification. We suggest that the perirhinal cortex is crucially involved in processing coherent concepts of individual objects. A deficit of this nature could underlie the pattern of impairments that follow perirhinal cortex damage in both visual object recognition memory and visual associative memory.     

Drinking over the life course within gender and ethnic groups: a hyperparametric analysis

Visual agnosia is a neuropsychological syndrome characterized by a failure of object identification. Apperceptive agnosia, an object identification deficit caused by damage to early perceptual processes, has been explained by appealing to both damaged early sensory processes and to damaged preattentive grouping processes. Which of these two explanations best accounts for the behavior of these patients? We present results from two experiments designed to distinguish rival theoretical accounts of apperceptive agnosia. In our studies, we attempted to simulate apperceptive agnosia in neurologically intact subjects. Sensory-deficit accounts of the syndrome predict that degrading visual processing would make normal subjects perform like patients; grouping-deficit accounts predict that removing perceptual organization cues from visual displays would make normal subjects perform like patients. We were able to simulate the behavior of an apperceptive agnosic patient by removing perceptual organization cues, consistent with a grouping-deficit account of this syndrome. The implications for understanding both apperceptive agnosia and normal visual functioning are discussed.     

A multimodal language region in the ventral visual pathway

Reading words and naming pictures involves the association of visual stimuli with phonological and semantic knowledge. Damage to a region of the brain in the left basal posterior temporal lobe (BA37), which is strategically situated between the visual cortex and the more anterior temporal cortex, leads to reading and naming deficits. Additional evidence implicating this region in linguistic processing comes from functional neuroimaging studies of reading in normal subjects and subjects with developmental dyslexia. Here we test whether the visual component of reading is essential for activation of BA37 by comparing cortical activations elicited by word processing in congenitally blind, late-blind and sighted subjects using functional neuroimaging. Despite the different modalities used (visual and tactile), all groups of subjects showed a common activation of BA37 by words relative to non-word letter-strings. These findings agree with the proposal that BA37 is an association area that integrates converging inputs from many regions. Our study confirms a prediction of theories of brain function that depend on convergence zones; the absence of one input (that is, visual) does not alter the response properties of such a convergence region.     

Dissociating emotion-induced blindness and hypervision.

Previous findings suggest that emotional stimuli sometimes improve (emotion-induced hypervision) and sometimes impair (emotion-induced blindness) the visual perception of subsequent neutral stimuli. We hypothesized that these differential carryover effects might be due to 2 distinct emotional influences in visual processing. On the one hand, emotional stimuli trigger a general enhancement in the efficiency of visual processing that can carry over onto other stimuli. On the other hand, emotional stimuli benefit from a stimulus-specific enhancement in later attentional processing at the expense of competing visual stimuli. We investigated whether detrimental (blindness) and beneficial (hypervision) carryover effects of emotion in perception can be dissociated within a single experimental paradigm. In 2 experiments, we manipulated the temporal competition for attention between an emotional cue word and a subsequent neutral target word by varying cue–target interstimulus interval (ISI) and cue visibility. Interestingly, emotional cues impaired target identification at short ISIs but improved target identification when competition was diminished by either increasing ISI or reducing cue visibility, suggesting that emotional significance of stimuli can improve and impair visual performance through distinct perceptual mechanisms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of kanji and kana reading on cerebral blood flow patterns measured by PET

To investigate the respective functions of pathways in processing visual information from different types of symbols, by positron emission tomography (PET) we examined the effect on cerebral blood flow (CBF) of reading the Japanese morphogram (kanji) versus the syllabogram (kana). Nine Japanese men were presented with three visual conditions in random order 2 minutes before the scan: eyes open controls, kanji morphogram reading, and kana syllabogram reading. Three words written in kanji or kana were shown, and subjects were instructed to read them silently and to identify the word unrelated logically to the other two. The reading and analyzing tasks activated wide areas of vision-related cortices. The comparison of the kanji and kana readings showed higher metabolism, with the former only in the posterior part of the primary visual cortex. Most of the CBF increases were common for both stimuli, although the patterns of these increases differed slightly. The correlation matrix of CBF change in the left hemisphere showed a ventral connection in kanji reading and a dorsal connection in kana reading. Our results suggest there is a functional differentiation in the brain between patterned and sequential perception when reading Japanese morphograms and syllabograms.     

Age-related changes in processing auditory stimuli during visual attention: Evidence for deficits in inhibitory control and sensory memory.

Age-related declines in attention and cognition have been associated with a difficulty in inhibiting the processing of task-irrelevant information (i.e., the inhibitory deficit hypothesis). However, evidence supporting the inhibitory deficit hypothesis remains equivocal, in part because of complexities in examining the processing of irrelevant stimuli using purely behavioral techniques. The effects of age on the processing of task-irrelevant stimuli were examined using scalp-recorded event-related brain potentials. Participants performed a visual discrimination task while standard and deviant auditory stimuli were presented in the background. Deviant auditory stimuli generated a mismatch negativity (MMN) wave that decreased with age, in part because of an age-related enhancement in sensory-evoked responses. The age-related changes in processing task-irrelevant auditory stimuli are consistent with the inhibitory deficit hypothesis and suggest that impaired inhibitory control of sensory input may play a role in the age-related declines in performance during selective attention tasks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preserved semantic priming effect in alexia

BH, a left-handed patient with alexia and nonfluent aphasia, was presented with a lexical-decision task in which words and pronounceable pseudowords were preceded by semantically related or unrelated picture primes (Experiment 1). In Experiment 2, BH was given an explicit reading task using the word lists from Experiment 1. Performance on Experiment 2 disclosed severe reading deficits in both oral reading and semantic matching of the words to pictures. However, in Experiment 1, BH demonstrated a significant semantic priming effect, responding more accurately and more quickly to words preceded by related primes than by unrelated primes. The present results suggest that even in a patient with severe alexia, implicit access to semantic information can be preserved in the absence of explicit identification. The possibility of categorical gradient in implicit activation (living vs. nonliving) in BH was also discussed, which, however, needs to be clarified in the further investigation.     

Performance on the visual cliff by cats with marginal gyrus lesions

Lesions in 12 cats that destroyed almost all of area 17 (Group MS) abolished differential responding on the visual cliff. Performance was not impaired in 9 cats in which regions of the striate cortex were spared in the depths of the splenial sulcus or in 23 cats with damage to extramarginal areas. There were 37 controls. Additional experiments indicated that the deficit in performance by MS cats was not reduced either by the administration of amphetamine or by increases in cues for motion parallax. Monocularly occluded normal cats preferred the shallow surface of the visual cliff, demonstrating that the deficit was not due solely to removal of neurons sensitive to binocular disparity. The findings were discussed in light of electrophysiological evidence that lesions of the visual cortex disrupt functions of the superior colliculus.     

Intralesionally implanted cisplatin plus systemic carmustine for the treatment of brain tumor in rats

Early alexia and higher visual impairments characterize Posterior cortical atrophy (PCA), a progressive dementing syndrome most often caused by Alzheimer disease. Posterior cortical atrophy is rare, and the nature of the visual impairments in PCA are unclear. The authors observed two patients who had an insidiously progressive reading difficulty characterized by letter-by-letter reading and otherwise intact cognitive functions. Over time, these patients developed "ventral simultanagnosia" with preserved detection of multiple stimuli but inability to interpret whole scenes. Subsequently, they progressed to Balint syndrome with "dorsal simultanagnosia," optic ataxia, and oculomotor apraxia. Structural imaging was normal, but functional imaging revealed posterior cortical dysfunction. On a letter reading task, both patients had a word superiority effect, and on a whole word reading task, they could not read most words with missing or crosshatched letters. An inability to assess whole scenes progressed to an inability to detect more than one stimulus in an array. These findings suggest an evolution of PCA with progressive difficulty in visual integration beginning with letters, progressing to whole scenes, and culminating in Balint syndrome. These changes may reflect an extension of the pathophysiology of PCA from the extrastriate visual cortex to its occipitotemporal and occipitoparietal connections.     

Right hemisphere performance and competence in processing mental images, in a case of partial interhemispheric disconnection

The objective of this study was to analyze dynamic aspects of right hemisphere implementation in processing visual images. Two tachistoscopic, divided visual field experiments were carried out on a partial split-brain patient with no damage to the right hemisphere. In the first experiment, image generation performance for letters presented in the right visual field (/left hemisphere) was undeniably optimal. In the left visual field (/right hemisphere), performance was no better than chance level at first, but then improved dramatically across stimulation blocks, in each of five successive sessions. This was interpreted as revealing the progressive spontaneous activation of the right hemisphere's competence not shown initially. The aim of the second experiment was to determine some conditions under which this pattern was obtained. The experimental design contrasted stimuli (words and pictures) and representational activity (phonologic and visuo-imaged processing). The right visual field (/left hemisphere: LH) elicited higher performance than the left visual field (/right hemisphere, RH) in the three situations where verbal activity was required. No superiority could be found when visual images were to be generated from pictures: parallel and weak improvement of both hemispheres was observed across sessions. Two other patterns were obtained: improvement in RH performance (although LH performance remained superior) and an unexpectedly large decrease in RH performance. These data are discussed in terms of RH cognitive competence and hemisphere implementation.     

Are hemispheric strategy differences independent of the level of performance?

Studies requiring identification of consonant-vowel-consonant (CVC) nonwords have suggested that attention is distributed more slowly or sequentially across the letters when they are presented to the right hemisphere than to the left hemisphere. Two experiments investigated whether hemispheric differences in processing strategy would be reduced with reductions of hemispheric differences in accuracy. The magnitude of visual field differences in accuracy was controlled by manipulating exposure duration, and the effect was observed on visual field differences in processing strategy. For both CVC identification (Experiment 1) and identification of nonletter symbols (Experiment 2), hemispheric strategy differences were independent of differences in accuracy. Both quantitative and qualitative hemispheric strategy differences in processing visual displays appear to depend on the nature of the stimuli and the nature of the processes they invoke. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A perceptual-economy account for the inverted-optimal viewing position effect.

In reading, fixation durations are longer when the eyes fall near the center of words than when fixation occurs toward the words' ends-the inverted-optimal viewing position (I-OVP) effect. This study assessed whether the I-OVP effect was based on the fixation position in the word or the fixation position in the visual stimulus. In Experiments 1-3, words were presented at variable locations within longer strings of symbols. On trials with short fixation durations, there were effects of fixation position in the string. When long fixations were made, there were effects of fixation position in the word. In Experiment 4, an I-OVP effect was found for meaningless number strings, and its strength depended on the task's processing demands. The findings show that (a) the I-OVP effect is unrelated to orthographic informativeness and (b) the eyes are not constrained to spend more time at the center of visual stimuli. These results support a perceptual-economy account: Fixations are held longer when the eyes are estimated to be at locations in words/stimuli in which greater amounts of information are anticipated. Implications for eye movements in reading are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Snakes and Cats in the Flower Bed: Fast Detection Is Not Specific to Pictures of Fear-Relevant Animals.

The observation that snakes and spiders are found faster among flowers and mushrooms than vice versa and that this search advantage is independent of set size supports the notion that fear-relevant stimuli are processed preferentially in a dedicated fear module. Experiment 1 replicated the faster identification of snakes and spiders but also found a set size effect in a blocked, but not in a mixed-trial, sequence. Experiment 2 failed to find faster identification of snake and spider deviants relative to other animals among flowers and mushrooms and provided evidence for a search advantage for pictures of animals, irrespective of their fear relevance. These findings suggest that results from the present visual search task cannot support the notion of preferential processing of fear relevance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hemispheric priming by meaningful and nonmeaningful symbols in language-trained chimpanzees (Pan troglodytes): Further evidence of a left hemisphere advantage.

Hemispheric priming was examined in 3 language-trained chimpanzees (Pan troglodytes) using a simple reaction time (RT) paradigm. Ss were required to hold down a response button until the occurrence of a response cue. A warning stimulus was presented to either the left visual field or the right visual field (RVF) before the response cue occurred. No warning stimulus was presented on control trials. The warning stimuli were geometric communicative symbols from 2 semantic categories: food and tools. A 3rd set of warning stimuli were familiar geometric symbols. Dependent measures included RT and the number of false-positive responses. RT data indicated an RVF advantage in priming when the warning stimuli were food or tool symbols. No significant visual half-field differences were found for familiar symbols, but a trend toward an RVF advantage was observed. These effects were enhanced when Ss responded with their left hand. False-positive data also indicated an RVF advantage for the food and tool warning stimuli. The data indicate that hemispheric asymmetries for processing communicative symbols are present in language-trained chimpanzees. (PsycINFO Database Record (c) 2010 APA, all rights reserved)