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Pinto Y, Villa MC, Siliquini S, Polonara G, Passamonti C, Lattanzi S, Foschi N, Fabri M, de Haan EHF. Visual integration across fixation: automatic processes are split but conscious processes remain unified in the split-brain. Front Hum Neurosci 2023; 17:1278025. [PMID: 38021222 PMCID: PMC10667445 DOI: 10.3389/fnhum.2023.1278025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/26/2023] [Indexed: 12/01/2023] Open
Abstract
The classic view holds that when "split-brain" patients are presented with an object in the right visual field, they will correctly identify it verbally and with the right hand. However, when the object is presented in the left visual field, the patient verbally states that he saw nothing but nevertheless identifies it accurately with the left hand. This interaction suggests that perception, recognition and responding are separated in the two isolated hemispheres. However, there is now accumulating evidence that this interaction is not absolute; for instance, split-brain patients are able to detect and localise stimuli anywhere in the visual field verbally and with either hand. In this study we set out to explore this cross-hemifield interaction in more detail with the split-brain patient DDC and carried out two experiments. The aim of these experiments is to unveil the unity of deliberate and automatic processing in the context of visual integration across hemispheres. Experiment 1 suggests that automatic processing is split in this context. In contrast, when the patient is forced to adopt a conscious, deliberate, approach, processing seemed to be unified across visual fields (and thus across hemispheres). First, we looked at the confidence that DDC has in his responses. The experiment involved a simultaneous "same" versus "different" matching task with two shapes presented either within one hemifield or across fixation. The results showed that we replicated the observation that split brain patients cannot match across fixation, but more interesting, that DDC was very confident in the across-fixation condition while performing at chance-level. On the basis of this result, we hypothesised a two-route explanation. In healthy subjects, the visual information from the two hemifields is integrated in an automatic, unconscious fashion via the intact splenium, and this route has been severed in DDC. However, we know from previous experiments that some transfer of information remains possible. We proposed that this second route (perhaps less visual; more symbolic) may become apparent when he is forced to use a deliberate, consciously controlled approach. In an experiment where he is informed, by a second stimulus presented in one hemifield, what to do with the first stimulus that was presented in the same or the opposite hemifield, we showed that there was indeed interhemispheric transfer of information. We suggest that this two-route model may help in clarifying some of the controversial issues in split-brain research.
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Affiliation(s)
- Yair Pinto
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain and Cognition (ABC) Center, University of Amsterdam, Amsterdam, Netherlands
| | | | - Sabrina Siliquini
- Child Neuropsychiatry Unit, Marche Polytechnic University, Ancona, Italy
| | - Gabriele Polonara
- Department of Odontostomatologic and Specialized Clinical Sciences, Marche Polytechnic University, Ancona, Italy
| | | | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Nicoletta Foschi
- Epilepsy Center-Neurological Clinic, Azienda “Ospedali Riuniti”, Ancona, Italy
| | - Mara Fabri
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Edward H. F. de Haan
- Department of Psychology, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Brain and Cognition (ABC) Center, University of Amsterdam, Amsterdam, Netherlands
- Donders Institute, Radboud University, Nijmegen, Netherlands
- St. Hugh’s College, Oxford University, Oxford, United Kingdom
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de Haan EHF, Scholte HS, Pinto Y, Foschi N, Polonara G, Fabri M. Singularity and consciousness: A neuropsychological contribution. J Neuropsychol 2021; 15:1-19. [PMID: 33522716 PMCID: PMC8048575 DOI: 10.1111/jnp.12234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 10/22/2020] [Indexed: 12/03/2022]
Abstract
In common sense experience based on introspection, consciousness is singular. There is only one ‘me’ and that is the one that is conscious. This means that ‘singularity’ is a defining aspect of ‘consciousness’. However, the three main theories of consciousness, Integrated Information, Global Workspace and Recurrent Processing theory, are generally not very clear on this issue. These theories have traditionally relied heavily on neuropsychological observations and have interpreted various disorders, such as anosognosia, neglect and split‐brain as impairments in conscious awareness without any reference to ‘the singularity’. In this review, we will re‐examine the theoretical implications of these impairments in conscious awareness and propose a new way how to conceptualize consciousness of singularity. We will argue that the subjective feeling of singularity can coexist with several disunified conscious experiences. Singularity awareness may only come into existence due to environmental response constraints. That is, perceptual, language, memory, attentional and motor processes may largely proceed unintegrated in parallel, whereas a sense of unity only arises when organisms need to respond coherently constrained by the affordances of the environment. Next, we examine from this perspective psychiatric disorders and psycho‐active drugs. Finally, we present a first attempt to test this hypothesis with a resting state imaging experiment in a split‐brain patient. The results suggest that there is substantial coherence of activation across the two hemispheres. These data show that a complete lesioning of the corpus callosum does not, in general, alter the resting state networks of the brain. Thus, we propose that we have separate systems in the brain that generate distributed conscious. The sense of singularity, the experience of a ‘Me‐ness’, emerges in the interaction between the world and response‐planning systems, and this leads to coherent activation in the different functional networks across the cortex.
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Affiliation(s)
- Edward H F de Haan
- Department of Psychology, University of Amsterdam, the Netherlands.,Amsterdam Brain & Cognition (ABC) Center, University of Amsterdam, the Netherlands
| | - Huibert Steven Scholte
- Department of Psychology, University of Amsterdam, the Netherlands.,Amsterdam Brain & Cognition (ABC) Center, University of Amsterdam, the Netherlands
| | - Yair Pinto
- Department of Psychology, University of Amsterdam, the Netherlands.,Amsterdam Brain & Cognition (ABC) Center, University of Amsterdam, the Netherlands
| | - Nicoletta Foschi
- Epilepsy Center-Neurological Clinic, Azienda "Ospedali Riuniti", Ancona, Italy
| | - Gabriele Polonara
- Department of Odontostomatologic and Specialized Clinical Sciences, Marche Polytechnic University, Ancona, Italy
| | - Mara Fabri
- Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
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Unified Visual Working Memory without the Anterior Corpus Callosum. Symmetry (Basel) 2020. [DOI: 10.3390/sym12122106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
One of the most fundamental, and most studied, human cognitive functions is working memory. Yet, it is currently unknown how working memory is unified. In other words, why does a healthy human brain have one integrated capacity of working memory, rather than one capacity per visual hemifield, for instance. Thus, healthy subjects can memorize roughly as many items, regardless of whether all items are presented in one hemifield, rather than throughout two visual hemifields. In this current research, we investigated two patients in whom either most, or the entire, corpus callosum has been cut to alleviate otherwise untreatable epilepsy. Crucially, in both patients the anterior parts connecting the frontal and most of the parietal cortices, are entirely removed. This is essential, since it is often posited that working memory resides in these areas of the cortex. We found that despite the lack of direct connections between the frontal cortices in these patients, working memory capacity is similar regardless of whether stimuli are all presented in one visual hemifield or across two visual hemifields. This indicates that in the absence of the anterior parts of the corpus callosum working memory remains unified. Moreover, it is important to note that memory performance was not similar across visual fields. In fact, capacity was higher when items appeared in the left visual hemifield than when they appeared in the right visual hemifield. Visual information in the left hemifield is processed by the right hemisphere and vice versa. Therefore, this indicates that visual working memory is not symmetric, with the right hemisphere having a superior visual working memory. Nonetheless, a (subcortical) bottleneck apparently causes visual working memory to be integrated, such that capacity does not increase when items are presented in two, rather than one, visual hemifield.
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Prete G, Fabri M, Foschi N, Tommasi L. Voice gender categorization in the connected and disconnected hemispheres. Soc Neurosci 2020; 15:385-397. [PMID: 32130082 DOI: 10.1080/17470919.2020.1734654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The role of the left and right hemispheres in processing the gender of voices is controversial, some evidence suggesting a bilateral involvement, some others suggesting a right-hemispheric superiority. We investigated this issue in a gender categorization task involving healthy participants and a male split-brain patient: female or male natural voices were presented in one ear during the simultaneous presentation of white noise in the other ear (dichotic listening paradigm). Results revealed faster responses by the healthy participants for stimuli presented in the left than in the right ear, although no asymmetries emerged between the two ears in the accuracy of both the patient and the control group. Healthy participants were also more accurate at categorizing female than male voices, and an opposite-gender bias emerged - at least in females - showing faster responses in categorizing voices of the opposite gender. The results support a bilateral hemispheric involvement in voice gender categorization, without asymmetries in the patient, but with a faster categorization when voices are directly presented to the right hemisphere in the healthy sample. Moreover, when the two hemispheres directly interact with one another, a faster categorization of voices of the opposite gender emerges, and it can be an evolutionary grounded bias.
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Affiliation(s)
- Giulia Prete
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara , Chieti, Italy
| | - Mara Fabri
- Department of Clinical and Experimental Medicine, Neuroscience and Cell Biology Section, Polytechnic University of Marche , Ancona, Italy
| | - Nicoletta Foschi
- Regional Epilepsy Center, Neurological Clinic, "Ospedali Riuniti" , Ancona, Italy
| | - Luca Tommasi
- Department of Psychological, Health and Territorial Sciences, "G. d'Annunzio" University of Chieti-Pescara , Chieti, Italy
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de Haan EHF, Fabri M, Dijkerman HC, Foschi N, Lattanzi S, Pinto Y. Unified tactile detection and localisation in split-brain patients. Cortex 2020; 124:217-223. [PMID: 31923846 PMCID: PMC7061321 DOI: 10.1016/j.cortex.2019.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 11/08/2019] [Accepted: 11/18/2019] [Indexed: 02/04/2023]
Abstract
In 'split-brain' patients, the corpus callosum has been surgically severed to alleviate medically intractable, severe epilepsy. The classic claim is that after removal of the corpus callosum an object presented in the right visual field will be identified correctly verbally and with the right hand but not with the left hand. When the object is presented in the left visual field the patient verbally states that he saw nothing but nevertheless identifies it accurately with the left hand. This interaction suggests that perception, recognition and responding are separated in the two isolated hemispheres. However, there is now accumulating evidence that this interaction is not absolute. Recently, we (Pinto et al., 2017) showed that accurate detection and location of stimuli anywhere in the visual field could be performed with both hands. In this study, we explored detection and localisation of tactile stimulation on the body. In line with our previous results, we observed that split-brain patients can signal detection and localisation with either hand anywhere on the body (be it the arm or the leg) but they remain unable to match positions touched on both arms or legs simultaneously. These results add to the evidence suggesting that the effects of removal of the corpus callosum may be less severe than sometimes claimed.
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Affiliation(s)
- Edward H F de Haan
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain & Cognition (ABC) Center, University of Amsterdam, the Netherlands.
| | - Mara Fabri
- Department of Experimental and Clinical Medicine, Marche Politechnical University, Ancona, Italy
| | | | - Nicoletta Foschi
- Epilepsy Center-Neurological Clinic, Azienda 'Ospedali Riuniti', Ancona, Italy
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Marche Politechnical University, Ancona, Italy
| | - Yair Pinto
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain & Cognition (ABC) Center, University of Amsterdam, the Netherlands
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Pinto Y, de Haan EH, Lamme VA. The Split-Brain Phenomenon Revisited: A Single Conscious Agent with Split Perception. Trends Cogn Sci 2017; 21:835-851. [DOI: 10.1016/j.tics.2017.09.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/24/2017] [Accepted: 09/05/2017] [Indexed: 11/16/2022]
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Pinto Y, Neville DA, Otten M, Corballis PM, Lamme VAF, de Haan EHF, Foschi N, Fabri M. Split brain: divided perception but undivided consciousness. Brain 2017; 140:1231-1237. [DOI: 10.1093/brain/aww358] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 11/30/2016] [Indexed: 11/12/2022] Open
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Fabri M, Pierpaoli C, Barbaresi P, Polonara G. Functional topography of the corpus callosum investigated by DTI and fMRI. World J Radiol 2014; 6:895-906. [PMID: 25550994 PMCID: PMC4278150 DOI: 10.4329/wjr.v6.i12.895] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 09/02/2014] [Accepted: 10/29/2014] [Indexed: 02/06/2023] Open
Abstract
This short review examines the most recent functional studies of the topographic organization of the human corpus callosum, the main interhemispheric commissure. After a brief description of its anatomy, development, microstructure, and function, it examines and discusses the latest findings obtained using diffusion tensor imaging (DTI) and tractography (DTT) and functional magnetic resonance imaging (fMRI), three recently developed imaging techniques that have significantly expanded and refined our knowledge of the commissure. While DTI and DTT have been providing insights into its microstructure, integrity and level of myelination, fMRI has been the key technique in documenting the activation of white matter fibers, particularly in the corpus callosum. By combining DTT and fMRI it has been possible to describe the trajectory of the callosal fibers interconnecting the primary olfactory, gustatory, motor, somatic sensory, auditory and visual cortices at sites where the activation elicited by peripheral stimulation was detected by fMRI. These studies have demonstrated the presence of callosal fiber tracts that cross the commissure at the level of the genu, body, and splenium, at sites showing fMRI activation. Altogether such findings lend further support to the notion that the corpus callosum displays a functional topographic organization that can be explored with fMRI.
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Polonara G, Mascioli G, Foschi N, Salvolini U, Pierpaoli C, Manzoni T, Fabri M, Barbaresi P. Further evidence for the topography and connectivity of the corpus callosum: an FMRI study of patients with partial callosal resection. J Neuroimaging 2014; 25:465-73. [PMID: 25039660 DOI: 10.1111/jon.12136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 02/21/2014] [Accepted: 03/02/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE This functional MRI study was designed to describe activated fiber topography and trajectories in the corpus callosum (CC) of six patients carrying different degree of partial callosal resection. METHODS Patients receiving gustatory, tactile, and visual stimulation according to a block-design protocol were scanned in a 1.5 Tesla magnet. Diffusion tensor imaging (DTI) data were also acquired to visualize spared interhemispheric fibers. RESULTS Taste stimuli evoked bilateral activation of the primary gustatory area in all patients and foci in the anterior CC, when spared. Tactile stimuli to the hand evoked bilateral foci in the primary somatosensory area in patients with an intact posterior callosal body and only contralateral in the other patients. Callosal foci occurred in the CC body, if spared. In patients with an intact splenium central visual stimulation induced bilateral activation of the primary visual area as well as foci in the splenium itself. CONCLUSION Present data show that interhemispheric fibers linking sensory areas crossed through the CC at the sites where the different sensory stimuli evoked activation foci, and that topography of callosal foci evoked by sensory stimulation in spared CC portions is consistent with that previously observed in subjects with intact CC.
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Affiliation(s)
- G Polonara
- Dipartimento di Scienze Cliniche Specialistiche e Odontostomatologiche, Università Politecnica delle Marche, Ancona, Italy
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Choudhri AF, Chin EM, Blitz AM, Gandhi D. Diffusion tensor imaging of cerebral white matter: technique, anatomy, and pathologic patterns. Radiol Clin North Am 2014; 52:413-25. [PMID: 24582347 DOI: 10.1016/j.rcl.2013.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diffusion tensor imaging is a magnetic resonance imaging technique that provides insight into the anatomy and integrity of white matter pathways in the brain. Further processing of these data can help map individual tracts, which can aid in surgical planning. Understanding the basics of this technique can improve characterization of white matter development and disorders.
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Affiliation(s)
- Asim F Choudhri
- Department of Radiology, University of Tennessee Health Science Center, 848 Adams Avenue, G216, Memphis, TN 38103, USA; Department of Neurosurgery, University of Tennessee Health Science Center, 848 Adams Avenue, G216, Memphis, TN 38103, USA; Department of Ophthalmology, University of Tennessee Health Science Center, 848 Adams Avenue, G216, Memphis, TN 38103, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, G216, Memphis, TN 38103, USA.
| | - Eric M Chin
- Department of Radiology, University of Tennessee Health Science Center, 848 Adams Avenue, G216, Memphis, TN 38103, USA
| | - Ari M Blitz
- Division of Neuroradiology, Department of Radiology and Radiological Science, Johns Hopkins University, 600 N Wolfe Street, B100, Baltimore, MD 21287, USA
| | - Dheeraj Gandhi
- Division of Neuroradiology, Department of Radiology, University of Maryland, 22 S Greene Street, Baltimore, MD 21201, USA; Department of Neurology, University of Maryland, 22 S Greene Street, Baltimore, MD 21201, USA; Department of Neurosurgery, University of Maryland, 22 S Greene Street, Baltimore, MD 21201, USA
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Choudhri AF, Whitehead MT, McGregor AL, Einhaus SL, Boop FA, Wheless JW. Diffusion tensor imaging to evaluate commissural disconnection after corpus callosotomy. Neuroradiology 2013; 55:1397-403. [DOI: 10.1007/s00234-013-1286-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 09/25/2013] [Indexed: 11/27/2022]
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12
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Guo LF, Geng J, Zhu X, Liu K, Liu C, Cui L. Relationship between the phase value of ESWAN and fractional anisotropy of diffusion tensor imaging in patients with cerebral microbleeds: preliminary results. Eur Neurol 2013; 70:210-7. [PMID: 23969637 DOI: 10.1159/000346638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 12/19/2012] [Indexed: 11/19/2022]
Abstract
AIMS The purpose of the present study was to measure phase values (PVs) and fractional anisotropy (FA) of cerebral microbleeds (CMBs) using phase and FA map, and to investigate the potential relationship between PVs and FAs in CMBs in vivo. METHODS We retrospectively analyzed 30 patients with CMBs using enhanced T2*-weighted angiography and diffusion tensor imaging. The PVs and FAs of CMBs were measured and documented, and the mean FAs were compared between CMBs and the corresponding normal brain tissue. The mean PVs were correlated with FAs in CMBs in seven different brain regions. RESULTS A total of 106 CMBs were defined, and the mean FA of the CMBs in white matter, EC/IC/CR, thalamus, and cerebellum were significantly lower than that of normal brain tissue in the control group (p<0.05). Positive correlations were observed between the PV and FA of CMBs in white matter, external capsule, internal capsule and corona radiata (r=0.70, 0.38). CONCLUSION Enhanced T2*-weighted angiography and diffusion tensor imaging sequence may be useful neuroimaging sequences that could reflect the severity of damage of white matter by measuring the FA of CMBs and provide useful reference data for the quantitative assessment of CMBs.
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Affiliation(s)
- Ling Fei Guo
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
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Fabri M, Polonara G. Functional topography of human corpus callosum: an FMRI mapping study. Neural Plast 2013; 2013:251308. [PMID: 23476810 PMCID: PMC3586479 DOI: 10.1155/2013/251308] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 11/26/2012] [Accepted: 12/04/2012] [Indexed: 12/13/2022] Open
Abstract
The concept of a topographical map of the corpus callosum (CC) has emerged from human lesion studies and from electrophysiological and anatomical tracing investigations in other mammals. Over the last few years a rising number of researchers have been reporting functional magnetic resonance imaging (fMRI) activation in white matter, particularly the CC. In this study the scope for describing CC topography with fMRI was explored by evoking activation through simple sensory stimulation and motor tasks. We reviewed our published and unpublished fMRI and diffusion tensor imaging data on the cortical representation of tactile, gustatory, auditory, and visual sensitivity and of motor activation, obtained in 36 normal volunteers and in 6 patients with partial callosotomy. Activation foci were consistently detected in discrete CC regions: anterior (taste stimuli), central (motor tasks), central and posterior (tactile stimuli), and splenium (auditory and visual stimuli). Reconstruction of callosal fibers connecting activated primary gustatory, motor, somatosensory, auditory, and visual cortices by diffusion tensor tracking showed bundles crossing, respectively, through the genu, anterior and posterior body, and splenium, at sites harboring fMRI foci. These data confirm that the CC commissure has a topographical organization and demonstrate that its functional topography can be explored with fMRI.
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Affiliation(s)
- Mara Fabri
- Sezione di Neuroscienze e Biologia Cellulare, Dipartimento di Medicina Sperimentale e Clinica, Università Politecnica delle Marche, 60020 Ancona, Italy.
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Diffusion tensor imaging in radiosurgical callosotomy. Seizure 2012; 21:473-7. [DOI: 10.1016/j.seizure.2012.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/25/2012] [Accepted: 03/27/2012] [Indexed: 11/20/2022] Open
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Ahn S, Lee SK. Diffusion tensor imaging: exploring the motor networks and clinical applications. Korean J Radiol 2011; 12:651-61. [PMID: 22043146 PMCID: PMC3194768 DOI: 10.3348/kjr.2011.12.6.651] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 06/03/2011] [Indexed: 01/23/2023] Open
Abstract
With the advances in diffusion magnetic resonance (MR) imaging techniques, diffusion tensor imaging (DTI) has been applied to a number of neurological conditions because DTI can demonstrate microstructures of the brain that are not assessable with conventional MR imaging. Tractography based on DTI offers gross visualization of the white matter fiber architecture in the human brain in vivo. Degradation of restrictive barriers and disruption of the cytoarchitecture result in changes in the diffusion of water molecules in various pathological conditions, and these conditions can also be assessed with DTI. Yet many factors may influence the ability to apply DTI clinically, so these techniques have to be used with a cautious hand.
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Affiliation(s)
- Sungsoo Ahn
- Department of Radiology, Yonsei University College of Medicine, Seoul 120-752, Korea
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Tasker RC, Westland AG, White DK, Williams GB. Corpus callosum and inferior forebrain white matter microstructure are related to functional outcome from raised intracranial pressure in child traumatic brain injury. Dev Neurosci 2010; 32:374-84. [PMID: 20829579 DOI: 10.1159/000316806] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 05/25/2010] [Indexed: 11/19/2022] Open
Abstract
In severe paediatric traumatic brain injury (TBI), a common focus of treatment is raised intracranial pressure (ICP). We have previously reported frontal cerebral vulnerability with executive deficits from raised ICP in paediatric TBI. Now, using diffusion tensor imaging (DTI) in a different population, we have examined fractional anisotropy (FA), and mean, axial and radial diffusivity (MD, AD, RD) in 4 regions of the corpus callosum (CC) and in both inferior frontal regions. Our aim was to examine during the chronic phase of TBI whether the CC cross-sectional area correlated with regional DTI metrics of white matter microstructure, with global outcome ratings of function (Functional Independence Measure and Multiattribute Health Status Classification) and with performance in the Rey-Osterrieth Complex Figure (ROCF) test. We examined 33 paediatric TBI cases who were followed, on average, 4.9 years after severe injury. All cases had received mechanical ventilation during their acute treatment and, a priori, they were assigned to a non-ICP or a raised ICP group. Twenty-two participants had mainly right-sided injury at the time of acute ictus. The findings confirm that severe TBI in childhood, complicated by intracranial hypertension, results in CC vulnerability. In the chronic phase of recovery, it is reduced in the cross-sectional area, it is more compact and thinned, and the anterior region is disproportionately small. Late after raised ICP, we have also found that individuals exhibit regional microstructural abnormality with combined reduced FA and increased MD, AD and RD. Smaller size and such microstructural changes in the anterior CC were associated with similar right-sided (rather than left-sided) frontal microstructural changes in the ICP group. Taken together, this evidence points to an interaction between raised ICP-related brain tissue perturbation and focal frontal extracallosal injury, leading to anterior CC regional vulnerability, most likely wallerian degeneration. At long-term follow-up, this lack of white matter integrity in the anterior CC is correlated with functional outcome, particularly in aspects of social interaction and the copy component of the ROCF test, which suggests that the CC-to-forebrain function warrants further study in chronic TBI.
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Affiliation(s)
- Robert C Tasker
- Department of Paediatrics, School of Clinical Medicine, University of Cambridge, Cambridge, UK.
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