Cortical reorganization of the visual system in post-stroke hemianopia studied with fMRI
Introduction: Restitution of unilateral visual field defects following occipital cortex lesions occurs rarely. Partial recovery, however, can be observed in patients with incomplete lesion of the visual cortex. Our objective was to study the neuroplastic changes in the visual system that underlie such recovery. Methods and Results: Six patients with a left PCA-territory cortical stroke and 6 healthy control subjects were studied during rest and during visual stimulation using a 1.5 T fMRI with a 40 mT gradient. Visual stimuli were projected with a laptop computer onto a 154 x 115 cm screen, placed 90 cm in front of the gantry. Subjects were asked to fixate a red point in the center of the screen during both conditions. During stimulation, a black-and-white checkerboard pattern reversal was presented in each hemifield. For each side, 120 volumes of 48 contiguous axial fMRI images were obtained during rest and during hemifield stimulation in alternating order (60 volumes for each condition). Significant differences of rCBF between stimulation and rest were assessed as group analyses using statistical parametric mapping (SPM 99; p<0.01, corrected for multiple comparison). In controls, strong increases of rCBF (Z=7.6) occurred in the contralateral primary visual cortex V1 (area 17) and in V3a (area 18) and V5 (area 19). No differences were found between the right and left side in controls. During stimulation of the unaffected (left) visual field in hemianopic patients, activation occurred in contralateral V1, but the strongest increases of rCBF (Z>10) were seen in contralateral V3a (area 18) and V5 (area 19). During stimulation of the hemianopic (right) visual field, no activation was found in the primary visual cortex of either hemisphere. The most significant activation (Z=9.2) was seen in the ipsilateral V3a and V5 areas, and contralateral (left) V3a. Conclusions: Partial recovery from hemianopia is associated with strong ipsilateral activation of the visual system. Processing of visual stimuli in the hemianopic side spares the primary visual cortex and may involve recruitment of neurons in ipsilateral (contralesional) areas V3a and V5.