Structural connectivity in a single case of progressive prosopagnosia: the role of the right inferior longitudinal fasciculus

What is developmental about developmental prosopagnosia?

Developmental prosopagnosia (DP) is characterised by difficulties recognising face identities and is associated with diverse co-occurring object recognition difficulties. The high co-occurrence rate and heterogeneity of associated difficulties in DP is an intrinsic feature of developmental conditions, where co-occurrence of difficulties is the rule, rather than the exception. However, despite its name, cognitive and neural theories of DP rarely consider the developmental context in which these difficulties occur. This leaves a large gap in our understanding of how DP emerges in light of the developmental trajectory of face recognition. Here, we argue that progress in the field requires re-considering the developmental origins of differences in face recognition abilities, rather than studying the end-state alone. In practice, considering development in DP necessitates a re-evaluation of current approaches in recruitment, design, and analyses.

The Neural Correlates of Developmental Prosopagnosia: Twenty-Five Years on

Faces play a crucial role in social interactions. Developmental prosopagnosia (DP) refers to the lifelong difficulty in recognizing faces despite the absence of obvious signs of brain lesions. In recent decades, the neural substrate of this condition has been extensively investigated. While early neuroimaging studies did not reveal significant functional and structural abnormalities in the brains of individuals with developmental prosopagnosia (DPs), recent evidence identifies abnormalities at multiple levels within DPs' face-processing networks. The current work aims to provide an overview of the convergent and contrasting findings by examining twenty-five years of neuroimaging literature on the anatomo-functional correlates of DP. We included 55 original papers, including 63 studies that compared the brain structure (MRI) and activity (fMRI, EEG, MEG) of healthy control participants and DPs. Despite variations in methods, procedures, outcomes, sample selection, and study design, this scoping review suggests that morphological, functional, and electrophysiological features characterize DPs' brains, primarily within the ventral visual stream. Particularly, the functional and anatomical connectivity between the Fusiform Face Area and the other face-sensitive regions seems strongly impaired. The cognitive and clinical implications as well as the limitations of these findings are discussed in light of the available knowledge and challenges in the context of DP.

The central role of the left inferior longitudinal fasciculus in the face-name retrieval network

Unsuccessful retrieval of proper names (PNs) is commonly observed in patients suffering from neurological conditions such as stroke or epilepsy. While a large body of works has suggested that PN retrieval relies on a cortical network centered on the left anterior temporal lobe (ATL), much less is known about the white matter connections underpinning this process. Sparse studies provided evidence for a possible role of the uncinate fasciculus, but the inferior longitudinal fasciculus (ILF) might also contribute, since it mainly projects into the ATL, interconnects it with the posterior lexical interface and is engaged in common name (CN) retrieval. To ascertain this hypothesis, we assessed 58 patients having undergone a neurosurgery for a left low-grade glioma by means of a famous face naming (FFN) task. The behavioural data were processed following a multilevel lesion approach, including location-based analyses, voxel-based lesion-symptom mapping (VLSM) and disconnection-symptom mapping. Different statistical models were generated to control for sociodemographic data, familiarity, biographical knowledge and control cognitive performances (i.e., semantic and episodic memory and CN retrieval). Overall, VLSM analyses indicated that damage to the mid-to-anterior part of the ventro-basal temporal cortex was especially associated with PN retrieval deficits. As expected, tract-oriented analyses showed that the left ILF was the most strongly associated pathway. Our results provide evidence for the pivotal role of the ILF in the PN retrieval network. This novel finding paves the way for a better understanding of the pathophysiological bases underlying PN retrieval difficulties in the various neurological conditions marked by white matter abnormalities.

A narrative review of the anatomy and function of the white matter tracts in language production and comprehension

Much is known about the role of cortical areas in language processing. The shift towards network approaches in recent years has highlighted the importance of uncovering the role of white matter in connecting these areas. However, despite a large body of research, many of these tracts’ functions are not well-understood. We present a comprehensive review of the empirical evidence on the role of eight major tracts that are hypothesized to be involved in language processing (inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, extreme capsule, middle longitudinal fasciculus, superior longitudinal fasciculus, arcuate fasciculus, and frontal aslant tract). For each tract, we hypothesize its role based on the function of the cortical regions it connects. We then evaluate these hypotheses with data from three sources: studies in neurotypical individuals, neuropsychological data, and intraoperative stimulation studies. Finally, we summarize the conclusions supported by the data and highlight the areas needing further investigation.

Common neural substrates of diverse neurodevelopmental disorders

Neurodevelopmental disorders are categorized and studied according to their manifestations as distinct syndromes. For instance, congenital prosopagnosia and dyslexia have largely non-overlapping research literatures and clinical pathways for diagnosis and intervention. On the other hand, the high incidence of neurodevelopmental comorbidities or co-existing extreme strengths and weaknesses suggest that transdiagnostic commonalities may be greater than currently appreciated. The core-periphery model holds that brain regions within the stable core perceptual and motor regions are more densely connected to one another compared to regions in the flexible periphery comprising multimodal association regions. This model provides a framework for the interpretation of neural data in normal development and clinical disorders. Considering network-level commonalities reported in studies of neurodevelopmental disorders, variability in multimodal association cortex connectivity may reflect a shared origin of seemingly distinct neurodevelopmental disorders. This framework helps to explain both comorbidities in neurodevelopmental disorders and profiles of strengths and weaknesses attributable to competitive processing between cognitive systems within an individual.

Twenty years of investigation with the case of prosopagnosia PS to understand human face identity recognition. Part II: Neural basis

Patient PS sustained her dramatic brain injury in 1992, the same year as the first report of a neuroimaging study of human face recognition. The present paper complements the review on the functional nature of PS's prosopagnosia (part I), illustrating how her case study directly, i.e., through neuroimaging investigations of her brain structure and activity, but also indirectly, through neural studies performed on other clinical cases and neurotypical individuals, inspired and constrained neural models of human face recognition. In the dominant right hemisphere for face recognition in humans, PS's main lesion concerns (inputs to) the inferior occipital gyrus (IOG), in a region where face-selective activity is typically found in normal individuals ('Occipital Face Area', OFA). Her case study initially supported the criticality of this region for face identity recognition (FIR) and provided the impetus for transcranial magnetic stimulation (TMS), intracerebral electrical stimulation, and cortical surgery studies that have generally supported this view. Despite PS's right IOG lesion, typical face-selectivity is found anteriorly in the middle portion of the fusiform gyrus, a hominoid structure (termed the right 'Fusiform Face Area', FFA) that is widely considered to be the most important region for human face recognition. This finding led to the original proposal of direct anatomico-functional connections from early visual cortices to the FFA, bypassing the IOG/OFA (lulu), a hypothesis supported by further neuroimaging studies of PS, other neurological cases and neuro-typical individuals with original visual stimulation paradigms, data recordings and analyses. The proposal of a lack of sensitivity to face identity in PS's right FFA due to defective reentrant inputs from the IOG/FFA has also been supported by other cases, functional connectivity and cortical surgery studies. Overall, neural studies of, and based on, the case of prosopagnosia PS strongly question the hierarchical organization of the human neural face recognition system, supporting a more flexible and dynamic view of this key social brain function.

Prosopagnosia following nonlanguage dominant inferior temporal lobe low-grade glioma resection in which the inferior longitudinal fasciculus was disrupted preoperatively: illustrative case

BACKGROUND

Prosopagnosia is a rare neurological condition characterized by the impairment of face perception with preserved visual processing and cognitive functioning and is associated with injury to the fusiform gyrus and inferior longitudinal fasciculus (ILF). Reports of this clinical impairment following resection of right temporal lobe diffuse gliomas in the absence of contralateral injury are exceedingly scarce and not expected as a complication of surgery.

OBSERVATIONS

The authors describe the case of a young female patient found to have an incidental diffuse glioma in the right inferior temporal lobe despite evidence of preoperative ILF disruption by the tumor. Following resection of the lesion, despite the preoperative disruption to the ILF by the tumor, the patient developed prosopagnosia. There was no evidence of contralateral, left-sided ILF injury.

LESSONS

Given the significant functional impairment associated with prosopagnosia, neurosurgeons should be aware of the exceedingly rare possibility of a visual-processing deficit following unilateral and, in this case, right-sided inferior temporal lobe glioma resections. More investigation is needed to determine whether preoperative testing can determine dominance of facial-processing networks for patients with lesions in the right inferior posterior temporooccipital lobe and whether intraoperative mapping could help prevent this complication.

Long-term sequelae of herpes simplex virus encephalitis-related white matter injury: correlation of neuropsychological outcome and diffusion tensor imaging

The pathophysiology of the memory impairment following Herpes Simplex virus encephalitis is not yet established and understood. This study attempts to elucidate the role of white matter injury and its impact on neuropsychological outcome in patients with history of Herpes Simplex virus encephalitis. This is a single-institution prospective study assessing 9 patients and 15 matched controls utilizing a combination of MRI with diffusion tensor imaging and neuropsychological testing. Tract-based spatial statistics analysis was performed and correlated with neuropsychological outcomes. Significantly decreased fractional anisotropy (FA) values were noted in corpus callosum, corona radiata, left posterior thalamic radiation, cingulum, superior longitudinal fasciculus, fornix, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, and uncinated fasciculus. Impaired facial recognition significantly correlated with reduction in FA of right uncinate fasciculus, right inferior longitudinal fasciculus, and splenium genu of corpus callosum. FA value of left cingulum significantly correlated with logical memory, auditory verbal learning. FA value of fornix correlated with visual recognition; FA value of left uncinate fasciculus with auditory verbal learning and delayed recall. In conclusion, this study demonstrates microstructural abnormalities involving several white matter tracts corresponding to neuropsychological deficits.

Structural impairments in hippocampal and occipitotemporal networks specifically contribute to decline in place and face category processing but not to other visual object categories in healthy aging

BACKGROUND

Functional neuroimaging studies have identified a set of nodes in the occipital-temporal cortex that preferentially respond to faces in comparison with other visual objects. By contrast, the processing of places seems to rely on parahippocampal cortex and structures heavily implicated in memory (e.g., the hippocampus). It has been suggested that human aging leads to decreased neural specialization of core face and place processing areas and impairments in face and place perception.

METHODS

Using mediation analysis, we tested the potential contribution of micro- and macrostructure within the hippocampal and occipitotemporal systems to age-associated effects in face and place category processing (as measured by 1-back working memory tasks) in 55 healthy adults (age range 23-79 years). To test for specific contributions of the studied structures to face/place processing, we also studied a distinct tract (i.e., the anterior thalamic radiation [ATR]) and cognitive performance for other visual object categories (objects, bodies, and verbal material). Constrained spherical deconvolution-based tractography was used to reconstruct the fornix, the inferior longitudinal fasciculus (ILF), and the ATR. Hippocampal volumetric measures were segmented from FSL-FIRST toolbox.

RESULTS

It was found that age associates with (a) decreases in fractional anisotropy (FA) in the fornix, in right ILF (but not left ILF), and in the ATR (b) reduced volume in the right and left hippocampus and (c) decline in visual object category processing. Importantly, mediation analysis showed that micro- and macrostructural impairments in the fornix and right hippocampus, respectively, associated with age-dependent decline in place processing. Alternatively, microstructural impairments in right hemispheric ILF associated with age-dependent decline in face processing. There were no other mediator effects of micro- and macrostructural variables on age-cognition relationships.

CONCLUSION

Together, the findings support specific contributions of the fornix and right hippocampus in visuospatial scene processing and of the long-range right hemispheric occipitotemporal network in face category processing.

The inferior longitudinal fasciculus: anatomy, function and surgical considerations

The inferior longitudinal fasciculus (ILF) is a large association white matter tract that interconnects, in a bidirectional manner, the occipital cortex to anterior temporal structures. In view of both its pattern of cortical projections and its recently evidenced multilayered anatomical organization, the ILF has been supposed to be vital for maintaining a wide range of cognitive and affective processes operating on the visual modality. As tumors commonly damage the temporal cortex, an updated knowledge of the functional anatomy of this ventral tract is needed to better map and monitor online its potential functions and thus to improve surgical outcomes. In this review, we first describe the gross anatomy of the ILF, its array of cortical terminations and its different layers. We then provide a comprehensive review of the functions that have been assigned to the tract. We successively address its role in object and face recognition, visual emotion recognition, language and semantic, including reading, and memory. It is especially shown that the ILF is critically involved in visually-guided behaviors, as its breakdown, both in sudden neurosurgical and progressive neurodegenerative diseases, is commonly associated with visual-specific neuropsychological syndromes (e.g. prosopagnosia and pure alexia, and so on). In the last section, we discuss the extent to which the ILF can reorganize in response to glioma infiltration and to surgery, and provide some reflections on how its intra-operative mapping may be refined.

White matter abnormalities of right hemisphere attention networks contribute to visual hallucinations in dementia with Lewy bodies

OBJECTIVE

Functional alterations of the visual attention networks in a setting of impaired visual information processing have a role in the genesis of visual hallucinations (VH) in dementia with Lewy bodies (DLB). This multimodal MRI study aims at exploring structural and functional basis of VH.

METHODS

23 DLB patients (10 with and 13 without VH) and 13 healthy controls were studied. They underwent MRI with T1-w sequences to measure cortical thickness, DTI for whole-brain and single tract microstructural properties and rs-fMRI of the default mode, dorsal and ventral attention, and visual networks.

RESULTS

In DLB with VH, whole-brain DTI revealed a lower fractional anisotropy and a greater mean diffusivity in the right frontal and temporo-parietal white matter tracts. Tracts dissection showed lower fractional anisotropy in the right inferior and superior (ventral part) longitudinal fasciculi (ILF and SLF) (p < .05, corrected), and greater mean diffusivity (p < .05). The extent of white matter microstructural alterations involving the right ILF and SLF correlated with the severity of VH (r = .55, p < .01; r = .42, p < .05, respectively), and with performance in the visual attention task (r = -.56 and r = -.61; p < .01, respectively). Cortical thickness in the projection areas of the right SLF was significantly reduced (p < .05). Patients with VH also showed an altered functional connectivity in the ventral attention network, connected by the ventral portion of the SLF (p < .05).

CONCLUSIONS

Our findings suggest that a combination of microstructural and functional alterations involving the attention networks in the right hemisphere may be important in the genesis of VH.

Prosopagnosia and disorders of face processing

Face recognition is a form of expert visual processing. Acquired prosopagnosia is the loss of familiarity for facial identity and has several functional variants, namely apperceptive, amnestic, and associative forms. Acquired forms are usually caused by either occipitotemporal or anterior temporal lesions, right or bilateral in most cases. In addition, there is a developmental form, whose functional and structural origins are still being elucidated. Despite their difficulties with recognizing faces, some of these subjects still show signs of covert recognition, which may have a number of explanations. Other aspects of face perception can be spared in prosopagnosic subjects. Patients with other types of face processing difficulties have been described, including impaired expression processing, impaired lip-reading, false familiarity for faces, and a people-specific amnesia. Recent rehabilitative studies have shown some modest ability to improve face perception in prosopagnosic subjects through perceptual training protocols.

Does the Right Focal Variant of Alzheimer's Disease Really Exist? A Literature Analysis

BACKGROUND

Alzheimer's disease (AD) is a clinically heterogeneous disease. Multiple atypical syndromes, distinct from the usual amnesic phenotype, have been described. In this context, the existence of a right variant of AD (RAD), characterized by enduring visuospatial impairment associated with right-sided asymmetric brain damage, has been proposed. However, to date, this phenotype remains controversial. In particular, its peculiar characteristics and the independence from more prevalent cases (especially the posterior cortical atrophy syndrome) have to be demonstrated.

OBJECTIVE

To explore the existence of focal RAD on the basis of existing literature.

METHODS

We performed a literature search for the description of atypical AD presentations, potentially evoking cases of focal RAD. To be considered as affected by RAD, the described cases had to present: 1) well documented right-sided asymmetry at neuroimaging; 2) predominant cognitive deficits localizable on the right hemisphere; 3) no specific diagnosis of a known variant of AD.

RESULTS

Twenty-one cases were found in the literature, but some of them were subsequently excluded because some features of a different clinical syndrome were overlapped with the clinical features of RAD. Thirteen positive cases, three of them with pathologically confirmed AD, remained. A common right clinical-radiological syndrome, characterized by memory and visuospatial impairment with temporal and parietal involvement, consistently emerged. However, the heterogeneity among the reports prevented a definitive and univocal description of the syndrome.

CONCLUSION

Even if sporadic observations strongly support the existence of a focal RAD, no definitive conclusions can still be drawn about it as an independent condition.

Latent atrophy factors related to phenotypical variants of posterior cortical atrophy

OBJECTIVE

To determine whether atrophy relates to phenotypical variants of posterior cortical atrophy (PCA) recently proposed in clinical criteria (i.e., dorsal, ventral, dominant-parietal, and caudal) we assessed associations between latent atrophy factors and cognition.

METHODS

We employed a data-driven Bayesian modeling framework based on latent Dirichlet allocation to identify latent atrophy factors in a multicenter cohort of 119 individuals with PCA (age 64 ± 7 years, 38% male, Mini-Mental State Examination 21 ± 5, 71% β-amyloid positive, 29% β-amyloid status unknown). The model uses standardized gray matter density images as input (adjusted for age, sex, intracranial volume, MRI scanner field strength, and whole-brain gray matter volume) and provides voxelwise probabilistic maps for a predetermined number of atrophy factors, allowing every individual to express each factor to a degree without a priori classification. Individual factor expressions were correlated to 4 PCA-specific cognitive domains (object perception, space perception, nonvisual/parietal functions, and primary visual processing) using general linear models.

RESULTS

The model revealed 4 distinct yet partially overlapping atrophy factors: right-dorsal, right-ventral, left-ventral, and limbic. We found that object perception and primary visual processing were associated with atrophy that predominantly reflects the right-ventral factor. Furthermore, space perception was associated with atrophy that predominantly represents the right-dorsal and right-ventral factors. However, individual participant profiles revealed that the large majority expressed multiple atrophy factors and had mixed clinical profiles with impairments across multiple domains, rather than displaying a discrete clinical-radiologic phenotype.

CONCLUSION

Our results indicate that specific brain behavior networks are vulnerable in PCA, but most individuals display a constellation of affected brain regions and symptoms, indicating that classification into 4 mutually exclusive variants is unlikely to be clinically useful.

Multi-Item Discriminability Pattern to Faces in Developmental Prosopagnosia Reveals Distinct Mechanisms of Face Processing

Previous studies have shown that individuals with developmental prosopagnosia (DP) show specific deficits in face processing. However, the mechanism underlying the deficits remains largely unknown. One hypothesis suggests that DP shares the same mechanism as normal population, though their faces processing is disproportionally impaired. An alternative hypothesis emphasizes a qualitatively different mechanism of DP processing faces. To test these hypotheses, we instructed DP and normal individuals to perceive faces and objects. Instead of calculating accuracy averaging across stimulus items, we used the discrimination accuracy for each item to construct a multi-item discriminability pattern. We found DP's discriminability pattern was less similar to that of normal individuals when perceiving faces than perceiving objects, suggesting that DP has qualitatively different mechanism in representing faces. A functional magnetic resonance imaging study was conducted to reveal the neural basis and found that multi-voxel activation patterns for faces in the right fusiform face area and occipital face area of DP were deviated away from the mean activation pattern of normal individuals. Further, the face representation was more heterogeneous in DP, suggesting that deficits of DP may come from multiple sources. In short, our study provides the first direct evidence that DP processes faces qualitatively different from normal population.

Abnormalities in the white matter tracts in patients with Parkinson disease and psychosis

OBJECTIVE

The objective of the current study was to compare the microstructural integrity of the white matter (WM) tracts in patients having Parkinson disease (PD) with and without psychosis (PD-P and PD-NP) through diffusion tensor imaging (DTI).

METHODS

This cross-sectional study involved 48 PD-NP and 42 PD-P who were matched for age, sex, and education. Tract-based spatial statistics (TBSS) was used to compare several DTI metrics from the diffusion-weighted MRIs obtained through a 3-Tesla scanner. A set of neuropsychological tests was used for the cognitive evaluation of all patients.

RESULTS

The severity and stage of PD were not statistically different between the groups. The PD-P group performed poorly in all the neuropsychological domains compared with the PD-NP group. TBSS analysis revealed widespread patterns of abnormality in the fractional anisotropy (FA) in the PD-P group, which also correlated with some of the cognitive scores. These tracts include inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, right parieto-occipital WM, body of the corpus callosum, and corticospinal tract.

CONCLUSION

This study provides novel insights into the putative role of WM tract abnormalities in the pathogenesis of PD-P by demonstrating significant alterations in several WM tracts. Additional longitudinal studies are warranted to confirm the findings of our research.

Revisiting the Functional Anatomy of the Human Brain: Toward a Meta-Networking Theory of Cerebral Functions

For more than one century, brain processing was mainly thought in a localizationist framework, in which one given function was underpinned by a discrete, isolated cortical area, and with a similar cerebral organization across individuals. However, advances in brain mapping techniques in humans have provided new insights into the organizational principles of anatomo-functional architecture. Here, we review recent findings gained from neuroimaging, electrophysiological, as well as lesion studies. Based on these recent data on brain connectome, we challenge the traditional, outdated localizationist view and propose an alternative meta-networking theory. This model holds that complex cognitions and behaviors arise from the spatiotemporal integration of distributed but relatively specialized networks underlying conation and cognition (e.g., language, spatial cognition). Dynamic interactions between such circuits result in a perpetual succession of new equilibrium states, opening the door to considerable interindividual behavioral variability and to neuroplastic phenomena. Indeed, a meta-networking organization underlies the uniquely human propensity to learn complex abilities, and also explains how postlesional reshaping can lead to some degrees of functional compensation in brain-damaged patients. We discuss the major implications of this approach in fundamental neurosciences as well as for clinical developments, especially in neurology, psychiatry, neurorehabilitation, and restorative neurosurgery.

Names and their meanings: A dual-process account of proper-name encoding and retrieval

The ability to pick out a unique entity with a proper name is an important component of human language. It has been a primary focus of research in the philosophy of language since the nineteenth century. Brain-based evidence has shed new light on this capacity, and an extensive literature indicates the involvement of distinct fronto-temporal and temporo-occipito-parietal association cortices in proper-name retrieval. However, comparatively few efforts have sought to explain how memory encoding processes lead to the later recruitment of these distinct regions at retrieval. Here, we provide a unified account of proper-name encoding and retrieval, reviewing evidence that socio-emotional and unitized encoding subserve the retrieval of proper names via anterior-temporal-prefrontal activations. Meanwhile, non-unitized item-item and item-context encoding support subsequent retrieval, largely dependent on the temporo-occipito-parietal cortex. We contend that this well-established divergence in encoding systems can explain how proper names are later retrieved from distinct neural structures. Furthermore, we explore how evidence reviewed here can inform a century-and-a-half-old debate about proper names and the meanings they pick out.

A Connectomic Atlas of the Human Cerebrum-Chapter 11: Tractographic Description of the Inferior Longitudinal Fasciculus

In this supplement, we seek to show a comprehensive anatomic atlas of the human cerebrum demonstrating all 180 distinct regions comprising the cerebral cortex. The location, functional connectivity, and structural connectivity of these regions are outlined, and where possible a discussion is included of the functional significance of these areas. In this chapter, we specifically address regions integrating to form the inferior longitudinal fasciculus.

Beyond Language: Mapping Cognition and Emotion

The use of intraoperative cognitive mapping and monitoring during awake surgery is not new, but this surgical approach has undergone important changes in recent years, especially in the context of low-grade glioma surgery. This rapid development is related to the growing awareness from neurosurgeons that sustaining quality of life in patients with a long-survival expectancy implies assessment and preservation of a range of important functions during surgery, beyond "overt" functions, such as language or motricity. Here we describe the different behavioral paradigms typically used, and how they are selected and modulated to identify and spare critical brain-wide cognitive systems.

Tests of whole upright face processing in prosopagnosia: A literature review

Prosopagnosia refers to an acquired or developmental deficit in face recognition. This neuropsychological impairment has received increasing attention over the last decade, in particular because of an increased scientific interest in developmental prosopagnosia. Studies investigating prosopagnosia have used a variety of different clinical and experimental tests to assess face processing abilities. With such a large variety of assessment methods available, test selection can be challenging. Some previous works have aimed to provide an overview of tests used to diagnose prosopagnosia. However, no overview that is based on a structured review of the literature is available. We review the literature to identify tests that have been used to assess the processing of whole upright faces in acquired and developmental prosopagnosia over the last five years (2013-2017). We not only review tests that have been used for diagnostic purposes, but also tests that have been used for experimental purposes. Tests are categorised according to i) their experimental designs and, ii) the stage of face processing that they assess. On this basis, we discuss considerations regarding test designs for future studies. A visual illustration providing a structured overview of paradigms available for testing the processing of whole upright faces is provided. This visual illustration can be used to inform test selection when designing a study and to apply a structured approach to interpreting findings from the literature. The different approaches to assessment of face processing in prosopagnosia have been necessary and fruitful in generating data and hypotheses about the cause of face processing deficits. However, impairments at different levels of face processing have often been interpreted as reflecting a deficit in the recognition stage of face processing. Based on the data now available on prosopagnosia, we advocate for a more structured approach to assessment, which may facilitate a better understanding of the key deficits in prosopagnosia and of the level(s) of face processing that are impaired.

Functional Anatomy of the Inferior Longitudinal Fasciculus: From Historical Reports to Current Hypotheses

The inferior longitudinal fasciculus (ILF) is a long-range, associative white matter pathway that connects the occipital and temporal-occipital areas of the brain to the anterior temporal areas. In view of the ILF's anatomic connections, it has been suggested that this pathway has a major role in a relatively large array of brain functions. Until recently, however, the literature data on these potential functions were scarce. Here, we review the key findings of recent anatomic, neuromodulation, and neuropsychological studies. We also summarize reports on how this tract is disrupted in a wide range of brain disorders, including psychopathologic, neurodevelopmental, and neurologic diseases. Our review reveals that the ILF is a multilayered, bidirectional tract involved in processing and modulating visual cues and thus in visually guided decisions and behaviors. Accordingly, sudden disruption of the ILF by neurologic insult is mainly associated with neuropsychological impairments of visual cognition (e.g., visual agnosia, prosopagnosia, and alexia). Furthermore, disruption of the ILF may constitute the pathophysiologic basis for visual hallucinations and socio-emotional impairments in schizophrenia, as well as emotional difficulties in autism spectrum disorder. Degeneration of the ILF in neurodegenerative diseases affecting the temporal lobe may explain (at least in part) the gradual onset of semantic and lexical access difficulties. Although some of the functions mediated by the ILF appear to be relatively lateralized, observations from neurosurgery suggest that disruption of the tract's anterior portion can be dynamically compensated for by the contralateral portion. This might explain why bilateral disruption of the ILF in either acute or progressive disease is highly detrimental in neuropsychological terms.

Disruption of Inferior Longitudinal Fasciculus Microstructure in Parkinson's Disease: A Systematic Review of Diffusion Tensor Imaging Studies

Parkinson's disease (PD) is a neurodegenerative disorder accompanied by a series of pathological mechanisms which contribute to a variety of motor and non-motor symptoms. Recently, there has been an increasing interest in structural diffusion tensor imaging (DTI) in PD which has shed light on our understanding of structural abnormalities underlying PD symptoms or its associations with pathological mechanisms. One of the white matter tracts shown to be disrupted in PD with a possible contribution to some PD symptoms is the inferior longitudinal fasciculus (ILF). On the whole, lower ILF integrity contributes to thought disorders, impaired visual emotions, cognitive impairments such as semantic fluency deficits, and mood disorders. This review outlines the microstructural changes in ILF associated with systemic inflammation and various PD symptoms like cognitive decline, facial emotion recognition deficit, depression, color discrimination deficit, olfactory dysfunction, and tremor genesis. However, few studies have investigated DTI correlates of each symptom and larger studies with standardized imaging protocols are required to extend these preliminary findings and lead to more promising results.

White matter pathways and social cognition

There is a growing consensus that social cognition and behavior emerge from interactions across distributed regions of the "social brain". Researchers have traditionally focused their attention on functional response properties of these gray matter networks and neglected the vital role of white matter connections in establishing such networks and their functions. In this article, we conduct a comprehensive review of prior research on structural connectivity in social neuroscience and highlight the importance of this literature in clarifying brain mechanisms of social cognition. We pay particular attention to three key social processes: face processing, embodied cognition, and theory of mind, and their respective underlying neural networks. To fully identify and characterize the anatomical architecture of these networks, we further implement probabilistic tractography on a large sample of diffusion-weighted imaging data. The combination of an in-depth literature review and the empirical investigation gives us an unprecedented, well-defined landscape of white matter pathways underlying major social brain networks. Finally, we discuss current problems in the field, outline suggestions for best practice in diffusion-imaging data collection and analysis, and offer new directions for future research.

A Quantitative Tractography Study Into the Connectivity, Segmentation and Laterality of the Human Inferior Longitudinal Fasciculus

The human inferior longitudinal fasciculus (ILF) is a ventral, temporo-occipital association tract. Though described in early neuroanatomical works, its existence was later questioned. Application of in vivo tractography to the neuroanatomical study of the ILF has generally confirmed its existence, however, consensus is lacking regarding its subdivision, laterality and connectivity. Further, there is a paucity of detailed neuroanatomic data pertaining to the exact anatomy of the ILF. Generalized Q-Sampling imaging (GQI) is a non-tensor tractographic modality permitting high resolution imaging of white-matter structures. As it is a non-tensor modality, it permits visualization of crossing fibers and accurate delineation of close-proximity fiber-systems. We applied deterministic GQI tractography to data from 30 healthy subjects and a large-volume, averaged diffusion atlas, to delineate ILF anatomy. Post-mortem white matter dissection was also carried out in three cadaveric specimens for further validation. The ILF was found in all 60 hemispheres. At its occipital extremity, ILF fascicles demonstrated a bifurcated, ventral-dorsal morphological termination pattern, which we used to further subdivide the bundle for detailed analysis. These divisions were consistent across the subject set and within the atlas. We applied quantitative techniques to study connectivity strength of the ILF at its anterior and posterior extremities. Overall, both morphological divisions, and the un-separated ILF, demonstrated strong leftward-lateralized connectivity patterns. Leftward-lateralization was also found for ILF volumes across the subject set. Due to connective and volumetric leftward-dominance and ventral location, we postulate the ILFs role in the semantic system. Further, our results are in agreement with functional and lesion-based postulations pertaining to the ILFs role in facial recognition.

Neuroanatomical correlates of haptic object processing: combined evidence from tractography and functional neuroimaging

Touch delivers a wealth of information already from birth, helping infants to acquire knowledge about a variety of important object properties using their hands. Despite the fact that we are touch experts as much as we are visual experts, surprisingly, little is known how our perceptual ability in touch is linked to either functional or structural aspects of the brain. The present study, therefore, investigates and identifies neuroanatomical correlates of haptic perceptual performance using a novel, multi-modal approach. For this, participants' performance in a difficult shape categorization task was first measured in the haptic domain. Using a multi-modal functional magnetic resonance imaging and diffusion-weighted magnetic resonance imaging analysis pipeline, functionally defined and anatomically constrained white-matter pathways were extracted and their microstructural characteristics correlated with individual variability in haptic categorization performance. Controlling for the effects of age, total intracranial volume and head movements in the regression model, haptic performance was found to correlate significantly with higher axial diffusivity in functionally defined superior longitudinal fasciculus (fSLF) linking frontal and parietal areas. These results were further localized in specific sub-parts of fSLF. Using additional data from a second group of participants, who first learned the categories in the visual domain and then transferred to the haptic domain, haptic performance correlates were obtained in the functionally defined inferior longitudinal fasciculus. Our results implicate SLF linking frontal and parietal areas as an important white-matter track in processing touch-specific information during object processing, whereas ILF relays visually learned information during haptic processing. Taken together, the present results chart for the first time potential neuroanatomical correlates and interactions of touch-related object processing.

Refining Surgical Corridors with Whole Brain Tractography: A Case Series

Recent advancements in automated diffusion tensor imaging (DTI) and whole brain tractography (WBT) may be of great use to the neurosurgeon in selecting surgical corridors that can minimize disruption of surrounding white matter tracts. This is especially important in cases where the lesion displaces white matter tracts and traditional operative approaches may inadvertently violate these fibers. Here, we present automated DTI seeding and WBT as a practical and efficient means for preoperative surgical planning, in an effort to spare white matter tracts that may be displaced by a variety of lesions and may be vulnerable during surgery. We retrospectively reviewed the records of seven patients with various intracranial lesions, who underwent preoperative magnetic resonance imaging (MRI) with automated DTI analysis. These images were used to guide operative planning so that we could select white matter corridors that would allow for minimal damage to vulnerable fiber tracts. The patients had various pathologies, ranging from neoplasms to intracranial hemorrhage, in a number of different intracranial locations. All the patients underwent preoperative intracranial imaging with post-processing of these images to generate white matter tracts. These images were then used to design an appropriate surgical approach that would minimize injury to white matter tracts. For the patients with neoplasms, all were totally or near-totally resected with a stability of symptoms postoperatively. In the case of the patient with intracranial hemorrhage, the hematoma was evacuated, with significant improvement in the postoperative period. Automated DTI seeding and WBT, which have become increasingly prevalent in recent years, can be of significant use to the neurosurgeon for preoperative planning. Their application is especially important in cases where white matter tracts are displaced by the lesion in question and are put at risk of injury during surgery. Using WBT to design customized surgical approaches appropriate to the case at hand can be of immense value in preserving these white matter tracts, minimizing postoperative deficits, and improving surgical outcomes. Further studies are needed to validate these results and better define their applicability to other regions and pathologies.

Altered topology of neural circuits in congenital prosopagnosia

Using a novel, fMRI-based inter-subject functional correlation (ISFC) approach, which isolates stimulus-locked inter-regional correlation patterns, we compared the cortical topology of the neural circuit for face processing in participants with an impairment in face recognition, congenital prosopagnosia (CP), and matched controls. Whereas the anterior temporal lobe served as the major network hub for face processing in controls, this was not the case for the CPs. Instead, this group evinced hyper-connectivity in posterior regions of the visual cortex, mostly associated with the lateral occipital and the inferior temporal cortices. Moreover, the extent of this hyper-connectivity was correlated with the face recognition deficit. These results offer new insights into the perturbed cortical topology in CP, which may serve as the underlying neural basis of the behavioral deficits typical of this disorder. The approach adopted here has the potential to uncover altered topologies in other neurodevelopmental disorders, as well.

DOI:http://dx.doi.org/10.7554/eLife.25069.001

Human babies prefer to look at faces and pictures of faces over any other object or pattern. A recent study found that even fetuses in the womb will turn their heads towards dots of light shone through the mother’s skin if the dots broadly resemble a face. Brain imaging studies show that face recognition depends on the coordinated activity of multiple brain regions. A core set of areas towards the back of the brain processes the visual features of faces, while regions elsewhere process more variable features such as emotional expressions.

Around 2% of people are born with difficulties in recognizing faces, a condition known as congenital prosopagnosia. These individuals have no obvious anatomical abnormalities in the brain, and brain scans reveal normal activity in core regions of the face processing network. So why do these people have difficulty with face recognition?

One possibility is that the condition reflects differences in the number of connections (or “connectivity”) between brain regions within the face processing network. To test this idea, Rosenthal et al. compared connectivity in individuals with congenital prosopagnosia with that in healthy volunteers. In the healthy volunteers, an area of the network called the anterior temporal cortex was highly connected to many other face processing regions: that is, it acted as a face processing hub. In individuals with congenital prosopagnosia, this hub-like connectivity was missing. Instead, a number of core regions involved in processing the basic visual features of faces, were more highly connected to one another. The greater this “hyperconnectivity”, the better the individual’s face processing abilities.

The findings of Rosenthal et al. pave the way for developing imaging-based tools to diagnose congenital prosopagnosia. The same approach could then be used to investigate the basis of other neurodevelopmental disorders that are thought to involve abnormal communication within brain networks, such as developmental dyslexia.

DOI:http://dx.doi.org/10.7554/eLife.25069.002

Consensus classification of posterior cortical atrophy

INTRODUCTION

A classification framework for posterior cortical atrophy (PCA) is proposed to improve the uniformity of definition of the syndrome in a variety of research settings.

METHODS

Consensus statements about PCA were developed through a detailed literature review, the formation of an international multidisciplinary working party which convened on four occasions, and a Web-based quantitative survey regarding symptom frequency and the conceptualization of PCA.

RESULTS

A three-level classification framework for PCA is described comprising both syndrome- and disease-level descriptions. Classification level 1 (PCA) defines the core clinical, cognitive, and neuroimaging features and exclusion criteria of the clinico-radiological syndrome. Classification level 2 (PCA-pure, PCA-plus) establishes whether, in addition to the core PCA syndrome, the core features of any other neurodegenerative syndromes are present. Classification level 3 (PCA attributable to AD [PCA-AD], Lewy body disease [PCA-LBD], corticobasal degeneration [PCA-CBD], prion disease [PCA-prion]) provides a more formal determination of the underlying cause of the PCA syndrome, based on available pathophysiological biomarker evidence. The issue of additional syndrome-level descriptors is discussed in relation to the challenges of defining stages of syndrome severity and characterizing phenotypic heterogeneity within the PCA spectrum.

DISCUSSION

There was strong agreement regarding the definition of the core clinico-radiological syndrome, meaning that the current consensus statement should be regarded as a refinement, development, and extension of previous single-center PCA criteria rather than any wholesale alteration or redescription of the syndrome. The framework and terminology may facilitate the interpretation of research data across studies, be applicable across a broad range of research scenarios (e.g., behavioral interventions, pharmacological trials), and provide a foundation for future collaborative work.

The visual white matter: The application of diffusion MRI and fiber tractography to vision science

Visual neuroscience has traditionally focused much of its attention on understanding the response properties of single neurons or neuronal ensembles. The visual white matter and the long-range neuronal connections it supports are fundamental in establishing such neuronal response properties and visual function. This review article provides an introduction to measurements and methods to study the human visual white matter using diffusion MRI. These methods allow us to measure the microstructural and macrostructural properties of the white matter in living human individuals; they allow us to trace long-range connections between neurons in different parts of the visual system and to measure the biophysical properties of these connections. We also review a range of findings from recent studies on connections between different visual field maps, the effects of visual impairment on the white matter, and the properties underlying networks that process visual information supporting visual face recognition. Finally, we discuss a few promising directions for future studies. These include new methods for analysis of MRI data, open datasets that are becoming available to study brain connectivity and white matter properties, and open source software for the analysis of these data.

"Can touch this": Cross-modal shape categorization performance is associated with microstructural characteristics of white matter association pathways

Previous studies on visuo-haptic shape processing provide evidence that visually learned shape information can transfer to the haptic domain. In particular, recent neuroimaging studies have shown that visually learned novel objects that were haptically tested recruited parts of the ventral pathway from early visual cortex to the temporal lobe. Interestingly, in such tasks considerable individual variation in cross-modal transfer performance was observed. Here, we investigate whether this individual variation may be reflected in microstructural characteristics of white-matter (WM) pathways. We first trained participants on a fine-grained categorization task of novel shapes in the visual domain, followed by a haptic categorization test. We then correlated visual training-performance and haptic test-performance, as well as performance on a symbol-coding task requiring visuo-motor dexterity with microstructural properties of WM bundles potentially involved in visuo-haptic processing (the inferior longitudinal fasciculus [ILF], the fronto-temporal part of the superior longitudinal fasciculus [SLF_ft ] and the vertical occipital fasciculus [VOF]). Behavioral results showed that haptic categorization performance was good on average but exhibited large inter-individual variability. Haptic performance also was correlated with performance in the symbol-coding task. WM analyses showed that fast visual learners exhibited higher fractional anisotropy (FA) in left SLF_ft and left VOF. Importantly, haptic test-performance (and symbol-coding performance) correlated with FA in ILF and with axial diffusivity in SLF_ft . These findings provide clear evidence that individual variation in visuo-haptic performance can be linked to microstructural characteristics of WM pathways. Hum Brain Mapp 38:842-854, 2017. © 2016 Wiley Periodicals, Inc.

Impairments in the Face-Processing Network in Developmental Prosopagnosia and Semantic Dementia

BACKGROUND

Developmental prosopagnosia (DP) and semantic dementia (SD) may be the two most common neurologic disorders of face processing, but their main clinical and pathophysiologic differences have not been established. To identify those features, we compared patients with DP and SD.

METHODS

Five patients with DP, five with right temporal-predominant SD, and ten normal controls underwent cognitive, visual perceptual, and face-processing tasks.

RESULTS

Although the patients with SD were more cognitively impaired than those with DP, the two groups did not differ statistically on the visual perceptual tests. On the face-processing tasks, the DP group had difficulty with configural analysis and they reported relying on serial, feature-by-feature analysis or awareness of salient features to recognize faces. By contrast, the SD group had problems with person knowledge and made semantically related errors. The SD group had better face familiarity scores, suggesting a potentially useful clinical test for distinguishing SD from DP.

CONCLUSIONS

These two disorders of face processing represent clinically distinguishable disturbances along a right hemisphere face-processing network: DP, characterized by early configural agnosia for faces, and SD, characterized primarily by a multimodal person knowledge disorder. We discuss these preliminary findings in the context of the current literature on the face-processing network; recent studies suggest an additional right anterior temporal, unimodal face familiarity-memory deficit consistent with an "associative prosopagnosia."

The white matter tracts of the cerebrum in ventricular surgery and hydrocephalus

OBJECTIVE The relationship of the white matter tracts to the lateral ventricles is important when planning surgical approaches to the ventricles and in understanding the symptoms of hydrocephalus. The authors' aim was to explore the relationship of the white matter tracts of the cerebrum to the lateral ventricles using fiber dissection technique and MR tractography and to discuss these findings in relation to approaches to ventricular lesions. METHODS Forty adult human formalin-fixed cadaveric hemispheres (20 brains) and 3 whole heads were examined using fiber dissection technique. The dissections were performed from lateral to medial, medial to lateral, superior to inferior, and inferior to superior. MR tractography showing the lateral ventricles aided in the understanding of the 3D relationships of the white matter tracts with the lateral ventricles. RESULTS The relationship between the lateral ventricles and the superior longitudinal I, II, and III, arcuate, vertical occipital, middle longitudinal, inferior longitudinal, inferior frontooccipital, uncinate, sledge runner, and lingular amygdaloidal fasciculi; and the anterior commissure fibers, optic radiations, internal capsule, corona radiata, thalamic radiations, cingulum, corpus callosum, fornix, caudate nucleus, thalamus, stria terminalis, and stria medullaris thalami were defined anatomically and radiologically. These fibers and structures have a consistent relationship to the lateral ventricles. CONCLUSIONS Knowledge of the relationship of the white matter tracts of the cerebrum to the lateral ventricles should aid in planning more accurate surgery for lesions within the lateral ventricles.

Variation in White Matter Connectivity Predicts the Ability to Remember Faces and Discriminate Their Emotions

OBJECTIVES

The extended face network contains clusters of neurons that perform distinct functions on facial stimuli. Regions in the posterior ventral visual stream appear to perform basic perceptual functions on faces, while more anterior regions, such as the ventral anterior temporal lobe and amygdala, function to link mnemonic and affective information to faces. Anterior and posterior regions are interconnected by a long-range white matter tracts; however, it is not known if variation in connectivity of these pathways explains cognitive performance.

METHODS

Here, we used diffusion imaging and deterministic tractography in a cohort of 28 neurologically normal adults ages 18-28 to examine microstructural properties of visual fiber pathways and their relationship to certain mnemonic and affective functions involved in face processing. We investigated how inter-individual variability in two tracts, the inferior longitudinal fasciculus (ILF) and the inferior fronto-occipital fasciculus (IFOF), related to performance on tests of facial emotion recognition and face memory.

RESULTS

Results revealed that microstructure of both tracts predicted variability in behavioral performance indexed by both tasks, suggesting that the ILF and IFOF play a role in facilitating our ability to discriminate emotional expressions in faces, as well as to remember unique faces. Variation in a control tract, the uncinate fasciculus, did not predict performance on these tasks.

CONCLUSIONS

These results corroborate and extend the findings of previous neuropsychology studies investigating the effects of damage to the ILF and IFOF, and demonstrate that differences in face processing abilities are related to white matter microstructure, even in healthy individuals.

Relearning knowledge for people in a case of right variant frontotemporal dementia

Right variant frontotemporal dementia (Rvt-FTD) is a rare variant of FTD that usually presents with a progressive difficulty in recognizing familiar people. We aimed to determine whether rehabilitation of semantic knowledge for people improves recognition by both verbal and visual channels in a patient with Rvt-FTD. Knowledge for 21 famous people was assessed in a patient with Rvt-FTD before and after completing a semantic rehabilitation program. After rehabilitation recognition increased by 95% when presented with the famous people's names and related semantic facts, but only by 28% when presented with their faces. Recognition of people by verbal and visual channels improves differently after semantic knowledge rehabilitation.

Local but not long-range microstructural differences of the ventral temporal cortex in developmental prosopagnosia

Individuals with developmental prosopagnosia (DP) experience face recognition impairments despite normal intellect and low-level vision and no history of brain damage. Prior studies using diffusion tensor imaging in small samples of subjects with DP (n=6 or n=8) offer conflicting views on the neurobiological bases for DP, with one suggesting white matter differences in two major long-range tracts running through the temporal cortex, and another suggesting white matter differences confined to fibers local to ventral temporal face-specific functional regions of interest (fROIs) in the fusiform gyrus. Here, we address these inconsistent findings using a comprehensive set of analyzes in a sample of DP subjects larger than both prior studies combined (n=16). While we found no microstructural differences in long-range tracts between DP and age-matched control participants, we found differences local to face-specific fROIs, and relationships between these microstructural measures with face recognition ability. We conclude that subtle differences in local rather than long-range tracts in the ventral temporal lobe are more likely associated with developmental prosopagnosia.

Dissociable roles of the inferior longitudinal fasciculus and fornix in face and place perception

We tested a novel hypothesis, generated from representational accounts of medial temporal lobe (MTL) function, that the major white matter tracts converging on perirhinal cortex (PrC) and hippocampus (HC) would be differentially involved in face and scene perception, respectively. Diffusion tensor imaging was applied in healthy participants alongside an odd-one-out paradigm sensitive to PrC and HC lesions in animals and humans. Microstructure of inferior longitudinal fasciculus (ILF, connecting occipital and ventro-anterior temporal lobe, including PrC) and fornix (the main HC input/output pathway) correlated with accuracy on odd-one-out judgements involving faces and scenes, respectively. Similarly, blood oxygen level-dependent (BOLD) response in PrC and HC, elicited during oddity judgements, was correlated with face and scene oddity performance, respectively. We also observed associations between ILF and fornix microstructure and category-selective BOLD response in PrC and HC, respectively. These striking three-way associations highlight functionally dissociable, structurally instantiated MTL neurocognitive networks for complex face and scene perception.

DOI:http://dx.doi.org/10.7554/eLife.07902.001

Perceiving an object or picture stimulates activity in the regions of the brain that make up the visual system. Some of these regions respond differently depending on what is being viewed: for example, some areas are more active when looking at faces, and others respond more when viewing places. One theory is that, rather than working in a self-contained fashion, category-sensitive brain regions are elements or ‘nodes’ within more complex brain networks that are specialised for processing different types of visual stimuli.

The inside of the brain contains regions of dark and light tissue. The lighter regions are known as ‘white matter’ and contain fibres that allow information to travel between different parts of the brain. These fibers may play an important role in how widely distributed brain regions communicate. To investigate this, Hodgetts, Postans et al. used a technique called diffusion MRI to measure the structure, or coherence, of white matter fibers in healthy volunteers. Brain activity was also measured while volunteers completed a task in which they needed to spot the odd-one-out from images of either faces or places.

Hodgetts, Postans et al. investigated the fine structure of a white matter fibre bundle known as the inferior longitudinal fasciculus (ILF). This fibre links two parts of the brain involved in face perception, called the occipital and anterior temporal lobes. Strikingly, ILF structure predicted both face-related brain activity in these regions and how well an individual could discriminate between faces, but not place stimuli.

By contrast, the ability of volunteers to tell apart different places (but not faces) was related to the structure of the fornix. The fornix is a bundle of white matter fibres that carries information to and from the hippocampus, a region that is important for finding one's way around an environment and remembering such journeys afterwards.

Hodgetts, Postans et al.'s findings suggest that the systems that process different visual categories are best thought of as large-scale distributed networks rather than a set of individual, specialised regions in the brain. In the future, research will be needed to further understand how white matter contributes to the perception of different visual categories, and to investigate in finer detail how visual experience influences the structure of white matter pathways.

DOI:http://dx.doi.org/10.7554/eLife.07902.002

Diffusion tensor imaging and white matter abnormalities in patients with disorders of consciousness

Progress in neuroimaging has yielded new powerful tools which, potentially, can be applied to clinical populations, improve the diagnosis of neurological disorders and predict outcome. At present, the diagnosis of consciousness disorders is limited to subjective assessment and objective measurements of behavior, with an emerging role for neuroimaging techniques. In this review we focus on white matter alterations measured using Diffusion Tensor Imaging on patients with consciousness disorders, examining the most common diffusion imaging acquisition protocols and considering the main issues related to diffusion imaging analyses. We conclude by considering some of the remaining challenges to overcome, the existing knowledge gaps and the potential role of neuroimaging in understanding the pathogenesis and clinical features of disorders of consciousness.

Beyond the FFA: The role of the ventral anterior temporal lobes in face processing

Extensive research has supported the existence of a specialized face-processing network that is distinct from the visual processing areas used for general object recognition. The majority of this work has been aimed at characterizing the response properties of the fusiform face area (FFA) and the occipital face area (OFA), which together are thought to constitute the core network of brain areas responsible for facial identification. Although accruing evidence has shown that face-selective patches in the ventral anterior temporal lobes (vATLs) are interconnected with the FFA and OFA, and that they play a role in facial identification, the relative contribution of these brain areas to the core face-processing network has remained unarticulated. Here we review recent research critically implicating the vATLs in face perception and memory. We propose that current models of face processing should be revised such that the ventral anterior temporal lobes serve a centralized role in the visual face-processing network. We speculate that a hierarchically organized system of face processing areas extends bilaterally from the inferior occipital gyri to the vATLs, with facial representations becoming increasingly complex and abstracted from low-level perceptual features as they move forward along this network. The anterior temporal face areas may serve as the apex of this hierarchy, instantiating the final stages of face recognition. We further argue that the anterior temporal face areas are ideally suited to serve as an interface between face perception and face memory, linking perceptual representations of individual identity with person-specific semantic knowledge.

Distributed circuits, not circumscribed centers, mediate visual recognition

Increasingly, the neural mechanisms that support visual cognition are being conceptualized as a distributed but integrated system, as opposed to a set of individual, specialized regions that each subserve a particular visual behavior. Consequently, there is an emerging emphasis on characterizing the functional, structural,and computational properties of these broad networks [corrected]. We present a novel theoretical perspective, which elucidates the developmental emergence, computational properties, and vulnerabilities of integrated circuits using face and word recognition as model domains. Additionally, we suggest that, rather than being disparate and independent, these neural circuits are overlapping and subject to the same computational constraints. Specifically, we argue that both word and face recognition rely on fine-grained visual representations but, by virtue of pressure to couple visual and language areas and to keep connection length short, the left hemisphere becomes more finely tuned for word recognition and, consequently, the right hemisphere becomes more finely tuned for face recognition. Thus, both hemispheres ultimately participate in both forms of visual recognition, but their respective contributions are asymmetrically weighted.

Selective dissociation between core and extended regions of the face processing network in congenital prosopagnosia

There is growing consensus that accurate and efficient face recognition is mediated by a neural circuit composed of a posterior "core" and an anterior "extended" set of regions. Here, we characterize the distributed face network in human individuals with congenital prosopagnosia (CP)-a lifelong impairment in face processing-relative to that of matched controls. Using functional magnetic resonance imaging, we first uncover largely normal activation patterns in the posterior core face patches in CP. We also document normal activity of the amygdala (emotion processing) as well as normal or even enhanced functional connectivity between the amygdala and the core regions. Critically, in the same individuals, activation of the anterior temporal cortex (identity processing) is reduced and connectivity between this region and the posterior core regions is disrupted. The dissociation between the neural profiles of the anterior temporal lobe and amygdala was evident both during a task-related face scan and during a resting state scan, in the absence of visual stimulation. Taken together, these findings elucidate selective disruptions in neural circuitry in CP and offer an explanation for the known differential difficulty in identity versus emotional expression recognition in many individuals with CP.