Dissociation between goal-directed and discrete response localization in a patient with bilateral cortical blindness

Action blindsight and antipointing in a hemianopic patient

Blindsight refers to the observation of residual visual abilities in the hemianopic field of patients without a functional V1. Given the within- and between-subject variability in the preserved abilities and the phenomenal experience of blindsight patients, the fine-grained description of the phenomenon is still debated. Here we tested a patient with established "perceptual" and "attentional" blindsight (c.f. Danckert and Rossetti, 2005). Using a pointing paradigm patient MS, who suffers from a complete left homonymous hemianopia, showed clear above chance manual localisation of 'unseen' targets. In addition, target presentations in his blind field led MS, on occasion, to spontaneous responses towards his sighted field. Structural and functional magnetic resonance imaging was conducted to evaluate the magnitude of V1 damage. Results revealed the presence of a calcarine sulcus in both hemispheres, yet his right V1 is reduced, structurally disconnected and shows no fMRI response to visual stimuli. Thus, visual stimulation of his blind field can lead to "action blindsight" and spontaneous antipointing, in absence of a functional right V1. With respect to the antipointing, we suggest that MS may have registered the stimulation and subsequently presumes it must have been in his intact half field.

Visual stimuli modulate frontal oscillatory rhythms in a cortically blind patient: Evidence for top-down visual processing

OBJECTIVE

We investigated neuronal correlates of faces versus non-faces processing in a cortically blind patient (TN) and a group of healthy age-matched controls in order to test electrophysiological correlates of the processing of pertinent stimuli in this patient.

METHODS

An EEG paradigm was used, in which intact and scrambled faces were displayed on a screen. First, time-frequency transforms were conducted on the patients' data alone. These oscillations were then compared to the frontal activity of six control participants.

RESULTS

Post stimulus oscillatory modulations (synchronisation in theta and alpha frequency bands) of both intact and scrambled faces at frontal scalp sites were observed in TN. These modulations were different for correct and incorrect responses. A more important increase in the theta band for incorrect responses was observed. The oscillatory rhythms highlighted in blindsight and in frontal regions differ from the ones observed in control participants.

CONCLUSION

Despite the destruction of the visual cortex, oscillatory rhythms are not cancelled out but are shifted to anterior regions, revealing the activity of an alternate pathway for residual visual function.

SIGNIFICANCE

The results provide evidence for a top-down cognitive control process in blindsight.

Visual Plasticity: Blindsight Bridges Anatomy and Function in the Visual System

Some people who are blind due to damage to their primary visual cortex, V1, can discriminate stimuli presented within their blind visual field. This residual function has been recently linked to a pathway that bypasses V1, and connects the thalamic lateral geniculate nucleus directly with the extrastriate cortical area MT.

The superior colliculus is sensitive to gestalt-like stimulus configuration in hemispherectomy patients

Patients with cortical blindness following a lesion to the primary visual cortex (V1) may retain nonconscious visual abilities (blindsight). One intriguing, though largely unexplored question, is whether nonconscious vision in the blind hemifield of hemianopic patients can be sensitive to higher-order perceptual organization, and which V1-independent structure underlies such effect. To answer this question, we tested two rare hemianopic patients who had undergone hemispherectomy, and in whom the only post-chiasmatic visual structure left intact in the same side of the otherwise damaged hemisphere was the superior colliculus (SC). By using a variant of the redundant target effect (RTE), we presented single dots, patterns composed by the same dots organized in quadruple gestalt-like configurations, or patterns of four dots arranged in random configurations, either singly to the intact visual hemifield or bilaterally to both hemifields. As reported in a number of prior studies on blindsight patients, we found that bilateral stimulation yielded faster reaction times (RTs) than single stimulation of the intact field for all conditions (i.e., there was an implicit RTE). In addition to this effect, both patients showed a further speeding up of RTs when the gestalt-like, but not the random shape, quadruple patterns were projected to their blind hemifield during bilateral stimulation. Because other retino-recipient subcortical and cortical structures in the damaged hemisphere are absent, the SC on the lesioned side seems solely responsible for such an effect. The present results provide initial support to the notion that nonconscious vision might be sensitive to perceptual organization and stimulus configuration through the pivotal contribution of the SC, which can enhance the processing of gestalt-like or structured stimuli over meaningless or randomly assembled ones and translate them into facilitatory motor outputs.

Looming sensitive cortical regions without V1 input: evidence from a patient with bilateral cortical blindness

Fast and automatic behavioral responses are required to avoid collision with an approaching stimulus. Accordingly, looming stimuli have been found to be highly salient and efficient attractors of attention due to the implication of potential collision and potential threat. Here, we address the question of whether looming motion is processed in the absence of any functional primary visual cortex and consequently without awareness. For this, we investigated a patient (TN) suffering from complete, bilateral damage to his primary visual cortex. Using an fMRI paradigm, we measured TN's brain activation during the presentation of looming, receding, rotating, and static point lights, of which he was unaware. When contrasted with other conditions, looming was found to produce bilateral activation of the middle temporal areas, as well as the superior temporal sulcus and inferior parietal lobe (IPL). The latter are generally thought to be involved in multisensory processing of motion in extrapersonal space, as well as attentional capture and saliency. No activity was found close to the lesioned V1 area. This demonstrates that looming motion is processed in the absence of awareness through direct subcortical projections to areas involved in multisensory processing of motion and saliency that bypass V1.

Acting without seeing: eye movements reveal visual processing without awareness

Visual perception and eye movements are considered to be tightly linked. Diverse fields, ranging from developmental psychology to computer science, utilize eye tracking to measure visual perception. However, this prevailing view has been challenged by recent behavioral studies. Here, we review converging evidence revealing dissociations between the contents of perceptual awareness and different types of eye movement. Such dissociations reveal situations in which eye movements are sensitive to particular visual features that fail to modulate perceptual reports. We also discuss neurophysiological, neuroimaging, and clinical studies supporting the role of subcortical pathways for visual processing without awareness. Our review links awareness to perceptual-eye movement dissociations and furthers our understanding of the brain pathways underlying vision and movement with and without awareness.

Lack of automatic attentional orienting by gaze cues following a bilateral loss of visual cortex

In social interactions, the location of relevant stimuli is often indicated by the orientation of gaze. It has been proposed that the direction of gaze might produce an automatic cueing of attention, similar to what is observed with exogenous cues. However, several reports have challenged this claim by demonstrating that the behavioral gain that arises with gaze cueing could be explained by shifts of attention, which are intentional and not automatic. We reasoned that if cueing by gaze was truly automatic, it should occur without awareness and should be sustained by subcortical circuits, including the amygdalae, independently of the main geniculo-striate visual pathway. We presented a cross-modal version of the Posner cueing paradigm to a patient (TN) with bilateral lesions of occipital cortex (Burra et al., 2013; Pegna, Khateb, Lazeyras, & Seghier, 2005). TN was asked to localize a sound using a key press. The location of the sound was congruent or incongruent with the direction of gaze of a face-cue. In groups of healthy young and age-matched participants, we observed significantly longer response times for incongruent than congruent sounds, suggesting that gaze direction interfered with processing of localized sounds. By contrast, TN׳s performance was not affected by sound-gaze congruence. The results suggest that the processing of gaze orientation cannot occur in the absence of geniculo-striate processing, suggesting that it is not automatic.

Emotional expressions modulate low α and β oscillations in a cortically blind patient

Studies of cortical blindness have suggested that some residual visual function may persist without perceptual awareness, a condition known as blindsight. To investigate electrophysiological evidence of unconscious processing of emotional stimuli, we examined the event-related oscillations (EROs) in a 62year-old male patient (TN) with affective blindsight during random stimulation of three facial expressions (fearful, happy and neutral). Spectral power analysis in response to the different emotions revealed significant differences between fearful and happy faces over the right frontal regions at 7-8Hz (low α), and between emotional and neutral faces over the left frontal sites at 12-13Hz (low β) in a time period between 100-400ms after visual stimulus onset. These results demonstrate that emotional face processing occurs very early in time in the absence of any functional striate cortex, and further reveals the existence of specific oscillatory frequencies that reflect unconscious processing of facial expressions in affective blindsight.