Akinetopsia: acute presentation and evidence for persisting defects in motion vision

Akinetopsia: A Systematic Review

ABSTRACT

Selective motion blindness, also known as akinetopsia, is infrequently reported in the literature. Hence, little is known about the condition including its causes, time course, pathophysiology, and current diagnostic methods. In this investigation, we comprehensively surveyed the literature using a systematic review to identify each reported case of the condition. The purpose of this study was to provide an exhaustive catalog of every published occurrence to date to identify and discuss trends, commonalities, and differences among them. Our results revealed distinct characteristics for the various etiologies of this phenomenon in addition to a shared pathophysiologic pathway among them.

[A case of Alice in Wonderland syndrome after Epstein-Barr virus (EBV) encephalitis: a mimicry of focal epileptic seizure]

A 30-year-old man who received infliximab for treatment of Crohn's disease developed Epstein-Barr virus (EBV) encephalitis, which responded well to therapy; however, he had left lower visual field loss following treatment. The patient noticed peculiar symptoms 9 months after recovery from encephalitis; objects in his view appeared smaller or larger than their actual size (micropsia/macropsia). Moreover, it appeared that objects outside moved faster or slower than their actual speed of movements and moving objects appeared as a series of many consecutive snap shots. His vision was blurred, and he had visual difficulties and a sensation that his body was floating. These symptoms mainly appeared following fatigue and persisted over approximately 10 years. Based on cerebrospinal fluid analysis, brain MRI, N-isopropyl-p-123I-iodoamphetamine with single photon emission computed tomography, fluorodeoxyglucose positron emission tomography, and electroencephalography, we excluded both recurrent encephalitis and focal epileptic seizures. By taking all symptoms and other evaluation findings into account, the patient most likely suffered from "Alice in Wonderland syndrome" which is primarily associated with cortical dysfunction in the right temporo-parieto-occipital area as the consequence of previous acute EBV encephalitis.

Central Ocular Motor Disorders: Clinical and Topographic Anatomical Diagnosis, Syndromes and Underlying Diseases

The key to the diagnosis of ocular motor disorders is a systematic clinical examination of the different types of eye movements, including eye position, spontaneous nystagmus, range of eye movements, smooth pursuit, saccades, gaze-holding function, vergence, optokinetic nystagmus, as well as testing of the function of the vestibulo-ocular reflex (VOR) and visual fixation suppression of the VOR. This is like a window which allows you to look into the brain stem and cerebellum even if imaging is normal. Relevant anatomical structures are the midbrain, pons, medulla, cerebellum and rarely the cortex. There is a simple clinical rule: vertical and torsional eye movements are generated in the midbrain, horizontal eye movements in the pons. For example, isolated dysfunction of vertical eye movements is due to a midbrain lesion affecting the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), with impaired vertical saccades only or vertical gaze-evoked nystagmus due to dysfunction of the Interstitial nucleus of Cajal (INC). Lesions of the lateral medulla oblongata (Wallenberg syndrome) lead to typical findings: ocular tilt reaction, central fixation nystagmus and dysmetric saccades. The cerebellum is relevant for almost all types of eye movements; typical pathological findings are saccadic smooth pursuit, gaze-evoked nystagmus or dysmetric saccades. The time course of the development of symptoms and signs is important for the diagnosis of underlying diseases: acute: most likely stroke; subacute: inflammatory diseases, metabolic diseases like thiamine deficiencies; chronic progressive: inherited diseases like Niemann-Pick type C with typically initially vertical and then horizontal saccade palsy or degenerative diseases like progressive supranuclear palsy. Treatment depends on the underlying disease. In this article, we deal with central ocular motor disorders. In a second article, we focus on clinically relevant types of nystagmus such as downbeat, upbeat, fixation pendular, gaze-evoked, infantile or periodic alternating nystagmus. Therefore, these types of nystagmus will not be described here in detail.

Visual Neuropsychology in Development: Anatomo-Functional Brain Mechanisms of Action/Perception Binding in Health and Disease

Vision is the main entrance for environmental input to the human brain. Even if vision is our most used sensory modality, its importance is not limited to environmental exploration. Rather it has strong links to motor competences, further extending to cognitive and social aspects of human life. These multifaceted relationships are particularly important in developmental age and become dramatically evident in presence of complex deficits originating from visual aberrancies. The present review summarizes the available neuropsychological evidence on the development of visual competences, with a particular focus on the associated visuo-motor integration skills in health and disease. With the aim of supporting future research and interventional settings, the goal of the present review is to constitute a solid base to help the translation of neuropsychological hypotheses into straightforward empirical investigations and rehabilitation/training protocols. This approach will further increase the impact, ameliorate the acceptance, and ease the use and implementation of lab-derived intervention protocols in real-life situations.

Motion perception and its disorders

As we live in a dynamic world, motion is a fundamental aspect of our visual experience. The advent of computerized stimuli has allowed controlled study of a wide array of motion phenomena, including global integration and segmentation, speed and direction discrimination, motion aftereffects, the optic flow that accompanies self-motion, perception of object form derived from motion cues, and point-light biological motion. Animal studies first revealed the existence of a motion-selective region, the middle temporal (MT) area, also known as V5, located in the lateral occipitotemporal cortex, followed by areas such as V5A (also known as MST, the middle superior temporal area), V6/V6A, the ventral intraparietal area, and others. In humans there are rare cases of bilateral lesions of the V5/V5A complex causing cerebral akinetopsia, a severe impairment of motion perception. Unilateral V5/V5A lesions are more common but cause milder asymptomatic deficits, often limited to the contralateral hemifield, while parietal lesions can impair perception of point-light biological motion or high-level motion tasks that are attentionally demanding. Impairments of motion perception have also been described in optic neuropathy, particularly glaucoma, as well as Alzheimer's disease, Parkinson's disease with dementia, and dementia with Lewy body disease. Prematurity with or without periventricular leukomalacia and developmental syndromes such as Williams' syndrome, autism, and dyslexia have also been associated with impaired motion perception, suggesting a developmental vulnerability of the dorsal pathway.

Time Distortions: A Systematic Review of Cases Characteristic of Alice in Wonderland Syndrome

Of the perceptual distortions characteristic of Alice in Wonderland syndrome, substantial alterations in the immediate experience of time are probably the least known and the most fascinating. We reviewed original case reports to examine the phenomenology and associated pathology of these time distortions in this syndrome. A systematic search in PubMed, Ovid Medline, and the historical literature yielded 59 publications that described 168 people experiencing time distortions, including 84 detailed individual case reports. We distinguished five different types of time distortion. The most common category comprises slow-motion and quick-motion phenomena. In 39% of all cases, time distortions were unimodal in nature, while in 61% there was additional involvement of the visual (49%), kinaesthetic (18%), and auditory modalities (14%). In all, 40% of all time distortions described were bimodal in nature and 19% trimodal, with 1% involving four modalities. Underlying neurological mechanisms are varied and may be triggered by intoxications, infectious diseases, metabolic disorders, CNS lesions, paroxysmal neurological disorders, and psychiatric disorders. Bizarre sensations of time alteration-such as time going backwards or moving in circles-were mostly associated with psychosis. Pathophysiologically, mainly occipital areas appear to be involved, although the temporal network is widely disseminated, with separate component timing mechanisms not always functioning synchronously, thus occasionally creating temporal mismatches within and across sensory modalities (desynchronization). Based on our findings, we propose a classification of time distortions and formulate implications for research and clinical practice.

Properties of smooth pursuit and visual motion reaction time to second-order motion stimuli

A large number of psychophysical and neurophysiological studies have demonstrated that smooth pursuit eye movements are tightly related to visual motion perception. This could be due to the fact that visual motion sensitive cortical areas such as meddle temporal (MT), medial superior temporal (MST) areas are involved in motion perception as well as pursuit initiation. Although the directional-discrimination and perceived target velocity tasks are used to evaluate visual motion perception, it is still uncertain whether the speed of visual motion perception, which is determined by visuomotor reaction time (RT) to a small target, is related to pursuit initiation. Therefore, we attempted to determine the relationship between pursuit latency/acceleration and the visual motion RT which was measured to the visual motion stimuli that moved leftward or rightward. The participants were instructed to fixate on a stationary target and press one of the buttons corresponding to the direction of target motion as soon as possible once the target starts to move. We applied five different visual motion stimuli including first- and second-order motion for smooth pursuit and visual motion RT tasks. It is well known that second-order motion induces lower retinal image motion, which elicits weaker responses in MT and MST compared to first-order motion stimuli. Our results showed that pursuit initiation including latency and initial eye acceleration were suppressed by second-order motion. In addition, second-order motion caused a delay in visual motion RT. The better performances in both pursuit initiation and visual motion RT were observed for first-order motion, whereas second-order (theta motion) induced remarkable deficits in both variables. Furthermore, significant Pearson's correlation and within-subjects correlation coefficients were obtained between visual motion RT and pursuit latency/acceleration. Our findings support the suggestion that there is a common neuronal pathway involved in both pursuit initiation and the speed of visual motion perception.

The effect of target speed on perception of visual motion direction in a patient with akinetopsia

Although much research has been devoted to the neural correlates of motion perception, the processing of speed of motion is still a topic of discussion. Apart from patient LM, no in-depth clinical research has been done in the past 20 years on this topic. In the present study, we investigated patient TD, who suffered from the rare disorder akinetopsia due to bilateral lesions of V5 after stroke. By means of a Random-Dot-Kinematogram (RDK) in which speed was varied systematically, it was found that TD was impaired in perceiving the direction of movement at speeds exceeding 9 deg/s. Our study suggests that V5 plays an important role in processing high-speed visual motion and further implies that V5 does not play a crucial role in processing low-speed visual motion. A remarkable finding, which has not been shown before, was that TD always reported the opposite direction of the actual movement at a speed of 24 deg/s. This suggests a form of the continuous wagon wheel illusion, which might have been caused by intact brain areas operating at different sampling rates than area V5.

Statokinetic Dissociation (Riddoch Phenomenon) in a Patient with Homonymous Hemianopsia as the First Sign of Posterior Cortical Atrophy

We report a 60-year-old woman with posterior cortical atrophy (PCA) who presented with left homonymous hemianopsia persisting for 5 years; the patient's condition was observed using static, but not kinetic, perimetry. This statokinetic dissociation of hemianopsia, which is often called Riddoch syndrome, might have been caused by a dysfunction of the right primary visual and visual association cortices, representing a functional imbalance within a disturbed visual cortex. In patients with PCA and visual field defects, both static and kinetic perimetry may be useful for understanding the extent of degeneration in the visual cortex, in addition to examinations of unilateral neglect.

Effects of cortical damage on binocular depth perception

Stereoscopic depth perception requires considerable neural computation, including the initial correspondence of the two retinal images, comparison across the local regions of the visual field and integration with other cues to depth. The most common cause for loss of stereoscopic vision is amblyopia, in which one eye has failed to form an adequate input to the visual cortex, usually due to strabismus (deviating eye) or anisometropia. However, the significant cortical processing required to produce the percept of depth means that, even when the retinal input is intact from both eyes, brain damage or dysfunction can interfere with stereoscopic vision. In this review, I examine the evidence for impairment of binocular vision and depth perception that can result from insults to the brain, including both discrete damage, temporal lobectomy and more systemic diseases such as posterior cortical atrophy.

This article is part of the themed issue ‘Vision in our three-dimensional world’.

Visual motion serves but is not under the purview of the dorsal pathway

Visual motion processing is often attributed to the dorsal visual pathway despite visual motion's involvement in almost all visual functions. Furthermore, some visual motion tasks critically depend on the structural integrity of regions outside the dorsal pathway. Here, based on numerous studies, I propose that visual motion signals are swiftly transmitted via multiple non-hierarchical routes to primary motion-dedicated processing regions (MT/V5 and MST) that are not part of the dorsal pathway, and then propagated to a multiplicity of brain areas according to task demands, reaching these regions earlier than the dorsal/ventral hierarchical flow. This not only places MT/V5 at the same or even earlier visual processing stage as that of V1, but can also elucidate many findings with implications to visual awareness. While the integrity of the non-hierarchical motion pathway is necessary for all visual motion perception, it is insufficient on its own, and the transfer of visual motion signals to additional brain areas is crucial to allow the different motion perception tasks (e.g. optic flow, visuo-vestibular balance, movement observation, dynamic form detection and perception, and even reading). I argue that this lateral visual motion pathway can be distinguished from the dorsal pathway not only based on faster response latencies and distinct anatomical connections, but also based on its full field representation. I also distinguish between this primary lateral visual motion pathway sensitive to all motion in the visual field, and a much less investigated optic flow sensitive medial processing pathway (from V1 to V6 and V6A) that appears to be part of the dorsal pathway. Multiple additional predictions are provided that allow testing this proposal and distinguishing between the visual pathways.

Some Unusual Neuropsychological Syndromes: Somatoparaphrenia, Akinetopsia, Reduplicative Paramnesia, Autotopagnosia

Some unusual neuropsychological syndromes are rarely reported in the neuropsychological literature. This paper presents a review of four of these unusual clinical syndromes: (1) somatoparaphrenia (delusional belief in which a patient states that the limb contralateral to a brain pathology, does not belong to him/her); (2) akinetopsia (cortical syndrome in which patient losses the ability to perceive visual motion); (3) reduplicative paramnesia (believe that a familiar place, person, object, or body part has been duplicated); and (4) autotopagnosia (disturbance of body schema involving the loss of ability to localize, recognize, or identify the specific parts of one's body). It is concluded that regardless of their rarity, it is fundamental to take them into consideration in order to understand how the brain organizes cognition; their understanding is also crucial in the clinical analysis of patients with brain pathologies.

Here, there and everywhere: higher visual function and the dorsal visual stream

The dorsal visual stream, often referred to as the 'where' stream, represents the pathway taken by visual information from the primary visual cortex to the posterior parietal lobe and onwards. It partners the ventral or 'what' stream, the subject of a previous review and largely a temporal-based system. Here, we consider the dorsal stream disorders of perception (simultanagnosia, akinetopsia) along with their consequences on action (eg, optic ataxia and oculomotor apraxia, along with Balint's syndrome). The role of the dorsal stream in blindsight and hemispatial neglect is also considered.

The contribution of LM to the neuroscience of movement vision

The significance of early and sporadic reports in the 19th century of impairments of motion vision following brain damage was largely unrecognized. In the absence of satisfactory post-mortem evidence, impairments were interpreted as the consequence of a more general disturbance resulting from brain damage, the location and extent of which was unknown. Moreover, evidence that movement constituted a special visual perception and may be selectively spared was similarly dismissed. Such skepticism derived from a reluctance to acknowledge that the neural substrates of visual perception may not be confined to primary visual cortex. This view did not persist. First, it was realized that visual movement perception does not depend simply on the analysis of spatial displacements and temporal intervals, but represents a specific visual movement sensation. Second persuasive evidence for functional specialization in extrastriate cortex, and notably the discovery of cortical area V5/MT, suggested a separate region specialized for motion processing. Shortly thereafter the remarkable case of patient LM was published, providing compelling evidence for a selective and specific loss of movement vision. The case is reviewed here, along with an assessment of its contribution to visual neuroscience.

The Zeitraffer phenomenon, akinetopsia, and the visual perception of speed of motion: a case report

The Zeitraffer phenomenon is the altered perception of the speed of moving objects. A single case is reported using the subject's own description of a transient alteration of the visual perception of motion. The literature on the subject is reviewed. The Zeitraffer phenomenon probably arises from dysfunction of brain networks subserving visual perception of speed. It shares characteristics with akinetopsia, the loss of visual ability to perceive motion.

Invisibility of moving objects: a core symptom of motion blindness

Although the higher brain mechanisms of seeing moving objects have been deeply investigated, motion blindness remains a rare and enigmatic symptom. Very few case reports well describe the detailed symptoms and the lesions. We report a case of a patient who presented with invisibility of moving objects, that is, motion blindness resulting from a unilateral right hemispheric lesion. This man, in his 60s, suffered persistent motion blindness from a unilateral right temporoparietal subcortical haemorrhage. He could not see the moving objects, just felt the objects 'disapper' when they began moving. The symptom was observed not only in his daily life but also during investigations in the hospital. To the best of our knowledge, this is the first report of a patient who showed persistent motion blindness with a right unilateral lesion, and only the second one with clinically apparent motion blindness, whose symptoms were similar to those of the first reported case.

Akinetopsia as epileptic seizure

Akinetopsia is a rare syndrome in which a patient specifically loses the ability to perceive visual motion following bilateral cortical lesions outside the striate cortex. We describe a patient who showed akinetopsia recurrently as epileptic seizures.

The patient was a 61-year-old man. At age 46, a cerebral arteriovenous malformation in the right parietal lobe was discovered. At age 58, he began to have a recurrent visual symptom by which smooth movements of objects suddenly appeared, resembling freeze frames in a motion picture. This symptom was paroxysmal and recurrent. Both EEG and magnetoencephalography showed repetitive right temporal spikes. We diagnosed his visual symptom as akinetopsia, which was aroused by hyperexcitability of the right temporal and parietal cortices, including area MT/V5. We administered carbamazepine 200 mg/day, which suppressed his akinetopsic symptom completely.