Submillisecond unmasked subliminal visual stimuli evoke electrical brain responses.

Subliminal perception is strongly associated to the processing of meaningful or emotional information and has mostly been studied using visual masking. In this study, we used high density 256-channel EEG coupled with an liquid crystal display (LCD) tachistoscope to characterize the spatio-temporal dynamics of the brain response to visual checkerboard stimuli (Experiment 1) or blank stimuli (Experiment 2) presented without a mask for 1 ms (visible), 500 µs (partially visible), and 250 µs (subliminal) by applying time-wise, assumption-free nonparametric randomization statistics on the strength and on the topography of high-density scalp-recorded electric field. Stimulus visibility was assessed in a third separate behavioral experiment. Results revealed that unmasked checkerboards presented subliminally for 250 µs evoked weak but detectable visual evoked potential (VEP) responses. When the checkerboards were replaced by blank stimuli, there was no evidence for the presence of an evoked response anymore. Furthermore, the checkerboard VEPs were modulated topographically between 243 and 296 ms post-stimulus onset as a function of stimulus duration, indicative of the engagement of distinct configuration of active brain networks. A distributed electrical source analysis localized this modulation within the right superior parietal lobule near the precuneus. These results show the presence of a brain response to submillisecond unmasked subliminal visual stimuli independently of their emotional saliency or meaningfulness and opens an avenue for new investigations of subliminal stimulation without using visual masking.

"Crossed" somatoparaphrenia: an unusual new case and a review of the literature.

Somatoparaphrenia is a delusional misidentification and confabulation of body parts, usually arm or hand, opposite to a cerebral lesion, generally of the "minor" right hemisphere. There is some controversy concerning lesion site (fronto-parietal; parieto-temporal; posterior insula, additional subcortical nuclei) or necessary associated symptoms (hemiparesis/plegia, anosognosia, neglect, position sense deficit). We here present a patient who is unusual in many respects, that is: (1) he is a right-hander with somatoparaphrenia after a "dominant" left-hemisphere lesion associated with aphasia and ideo-motor apraxia, but also with right hemineglect. He thus has "crossed" somatoparaphrenia; (2) his delusional misidentification concerned the right leg and not the arm or hand; (3) he has no anosognosia; (4) his proprioception is disturbed for the leg only; and (5) the lesion site is very posterior, a left occipito-parietal haemorrhage without involvement of the frontal lobe or the posterior insula. We present this case together with the seven other cases of "crossed somatoparaphrenia" with and without aphasia we found since 1935 in the literature and discuss their relevance in relation to the above controversies.

Very early processing of emotional words revealed in temporoparietal junctions of both hemispheres by EEG and TMS.

We investigate the contribution of both hemispheres in a lateralised lexical decision paradigm with emotional and neutral words in healthy volunteers. In a first experiment, high-density EEG analysis using source imaging methods revealed early specific participation of the temporoparietal junctions (TPJ) in both hemispheres for the detection of words. Then, in an event-related transcranial magnetic stimulation experiment with the same task, the disruption of left or right TPJ compared with a control stimulation over the vertex showed a slowing that is more pronounced when words are emotional and presented in the left visual field (LVF). This indicates that interference with both left and right TPJ results in impaired processing of words that were presented to the LVF. In addition, these results point to a specific cooperative contribution of the right hemisphere in the processing of words with emotional content compared with neutral words at very early stages. Results from the two experiments can be integrated in a brain-based spatiotemporal model of the early detection of written words.

An LCD tachistoscope with submillisecond precision.

Tachistoscopes allow brief visual stimulation delivery, which is crucial for experiments in which subliminal presentation is required. Up to now, tachistoscopes have had shortcomings with respect to timing accuracy, reliability, and flexibility of use. Here, we present a new and inexpensive two-channel tachistoscope that allows for exposure durations in the submillisecond range with an extremely high timing accuracy. The tachistoscope consists of two standard liquid-crystal display (LCD) monitors of the light-emitting diode (LED) backlight type, a semipermeable mirror, a mounting rack, and an experimental personal computer (PC). The monitors have been modified to provide external access to the LED backlights, which are controlled by the PC via the standard parallel port. Photodiode measurements confirmed reliable operation of the tachistoscope and revealed switching times of 3 µs. Our method may also be of great advantage in single-monitor setups, in which it allows for manipulating the stimulus timing with submillisecond precision in many experimental situations. Where this is not applicable, the monitor can be operated in standard mode by disabling the external backlight control instantaneously.

Can postictal memory predict postoperative memory in patients with temporal lobe epilepsy?

We investigated the contribution of postictal memory testing for lateralizing the epileptic focus and predicting memory outcome after surgery for temporal lobe epilepsy (TLE). Forty-five patients with TLE underwent interictal, postictal, and postoperative assessment of verbal and nonverbal memory. Surgery consisted of anterior temporal lobectomy (36), selective isolated amygdalohippocampectomy (6), or amygdalohippocampectomy coupled to lesionectomy (3). Postictal and postoperative but not interictal memory were significantly lower in left TLE than in right TLE. Nonverbal memory showed no significant difference in left TLE versus right TLE in all conditions. Postictal memory was significantly correlated with postoperative memory, but the effect disappeared when the lateralization of the focus was considered. Postictal verbal memory is a useful bedside tool that can help lateralize the epileptic focus. Larger studies are needed to further estimate its predictive value of the postoperative outcome.

Crossed ataxia: a case report and a diffusion tensor imaging tractography study.

BACKGROUND AND PURPOSE: Ever since the seminal description of ataxic hemiparesis contralateral to a pontine lesion by Miller-Fisher, the question of why contralesional crossing pontocerebellar fibers do not more frequently produce ipsilesional hemiataxia was raised. The few cases of "quadrataxic hemiparesis" or bilateral leg ataxia remain exceptions. SUMMARY OF CASE: We report an even more unusual variant, namely "crossed ataxia" of the contralesional arm and the ipsilesional leg subsequent to an anteromedial pontine ischemic stroke. CONCLUSIONS: MRI diffusion tensor imaging tractography shows that caudal contralesional crossing pontocerebellar fibers (those for the leg) travel trough the lesion, whereas more rostral fibers (those for the arm) are spared.

Simultaneous Doppelgänger and limb amputation impression in right frontal opercular stroke.

A case is described of a patient who presented almost simultaneously the impression that his left arm was amputated and the feeling of the presence of his invisible Doppelgänger. While these body scheme disorders have both been described after (right) parietal lesions, a right frontal opercular ischaemic stroke was found in the neurological work up. Diffusion tensor imaging showed that the stroke involved the ventral bundle of the superior longitudinal fasciculus that connects the parietal to the frontal lobe. The unusual clinical presentation of this frontal lesion may have been due to a 'diaschisis'-like phenomenon via the superior longitudinal fasciculus.

Complementary deficits in perceptual classification in pure alexia and acquired prosopagnosia - New insights from two classic cases.

Pure alexia and prosopagnosia traditionally have been seen as prime examples of dissociated, category-specific agnosias affecting reading and face recognition, respectively. More recent accounts have moved towards domain-independent explanations that postulate potential cross-links between different types of visual agnosia. According to one proposal, abnormal crowding, i.e. the impairment of recognition when features of adjacent objects are positioned too closely to each other, might provide a unified account for the perceptual deficits experienced by an agnosic patient. An alternative approach is based on the notion of complementary visual subsystems favouring the processing of abstract categories and specific exemplars, respectively. To test predictions of these two approaches with regard to pure alexia and prosopagnosia, we present previously unpublished data on digit recognition and visual crowding from two in the neuropsychological literature extensively studied patients, KD and MT (e.g., Campbell et al., 1986; Landis and Regard, 1988; Rentschler et al., 1994). Patient MT, diagnosed with pure alexia, showed pronounced abnormal foveal crowding, whereas KD, diagnosed with prosopagnosia, did not. These results form a distinct double dissociation with the performance of the two patients in other perceptual classification tasks involving Gabor micropatterns and textures, as well as Glass patterns, which revealed a significantly greater impairment in KD relative to MT. Based on an analysis of the specific task demands we argue that prosopagnosia and pure alexia may involve complementary deficits in instantiation and abstraction, respectively, during perceptual classification, beyond any category specificity. Such an explanation appears in line with previous distinctions between a predominantly left-hemispheric, abstract-category and a predominantly right-hemispheric, specific-exemplar subsystem underlying object recognition.

The neural substrates and timing of top-down processes during coarse-to-fine categorization of visual scenes: a combined fMRI and ERP study.

Spatial frequencies in an image influence visual analysis across a distributed, hierarchically organized brain network. Low spatial frequency (LSF) information may rapidly reach high-order areas to allow an initial coarse parsing of the visual scene, which could then be "retroinjected" through feedback into lower level visual areas to guide finer analysis on the basis of high spatial frequency (HSF). To test this "coarse-to-fine" processing scheme and to identify its neural substrates in the human brain, we presented sequences of two spatial-frequency-filtered scenes in rapid succession (LSF followed by HSF or vice versa) during fMRI and ERPs in the same participants. We show that for low-to-high sequences (but not for high-to-low sequences), LSF produces a first increase of activity in prefrontal and temporo-parietal areas, followed by enhanced responses to HSF in primary visual cortex. This pattern is consistent with retroactive influences on low-level areas that process HSF after initial activation of higher order areas by LSF.

Seeing the phantom: a functional magnetic resonance imaging study of a supernumerary phantom limb.

OBJECTIVE: Supernumerary phantom limb (SPL) is a rare neurological manifestation where patients with a severe stroke-induced sensorimotor deficit experience the illusory presence of an extra limb that duplicates a real one. The illusion is most often experienced as a somesthetic phantom, but rarer SPLs may be intentionally triggered or seen. Here, we report the case of a left visual, tactile, and intentional SPL caused by right subcortical damage in a nondeluded woman. METHODS: Using functional magnetic resonance imaging, we investigated the multimodal nature of this phantom, which the patient claimed to be able see, use, and move intentionally. The patient participated in a series of sensorimotor and motor imagery tasks involving the right, the left plegic, and the SPL's hand. RESULTS: Right premotor and motor regions were engaged when she imagined that she was scratching her left cheek with her left plegic hand, whereas when she performed the same task with the SPL, additional left middle occipital areas were recruited. Moreover, comparison of responses induced by left cheek (subjectively feasible) versus right cheek scratching (reportedly unfeasible movement) with the SPL demonstrated significant activation in right somesthetic areas. INTERPRETATION: These findings demonstrate that intentional movements of a seen and felt SPL activate premotor and motor areas together with visual and sensory cortex, confirming its multimodal dimension and the reliability of the patient's verbal reports. This observation, interpreted for cortical deafferentation/disconnection caused by subcortical brain damage, constitutes a new but theoretically predictable entity among disorders of bodily awareness.

On the origin of the N400 effects: an ERP waveform and source localization analysis in three matching tasks.

The question of the cognitive nature and the cerebral origins of the event-related potential (ERP) N400 component has frequently been debated. Here, the N400 effects were analyzed in three tasks. In the semantic task, subjects decided whether sequentially presented word pairs were semantically related or unrelated. In the phonologic (rhyme detection) task, they decided if words were phonologically related or not. In the image categorization task, they decided whether images were categorically related or not. Difference waves between ERPs to unrelated and related conditions (defined here as the N400 effect) demonstrated a greater amplitude and an earlier peak latency effect in the image than in semantic and phonologic tasks. In contrast, spatial correlation analysis revealed that the maps computed during the peak of the N400 effects were highly correlated. Source localization computed from these maps showed the involvement in all tasks of the middle/superior temporal gyrus. Our results suggest that these qualitatively similar N400 effects index the same cognitive content despite differences in the representational formats (words vs. images) and the types of mismatch (semantic vs. phonological) across tasks.

Right parietal brain activity precedes perceptual alternation of bistable stimuli.

Momentary fluctuations of baseline activity have been shown to influence responses to sensory stimulation both behaviorally and neurophysiologically. This suggests that perceptual awareness does not solely arise from physical stimulus properties. Here we studied whether the momentary state of the brain immediately before stimulus presentation indicates how a physically unique but perceptually ambiguous stimulus will be perceived. A complex Necker cube was intermittently presented and subjects indicated whether their perception changed with respect to the preceding presentation. EEG was recorded from 256 channels. The prestimulus brain-state was defined as the spatial configuration of the scalp potential map within the 50 ms before stimulus arrival, representing the sum of all momentary ongoing brain processes. Two maps were found that doubly dissociated perceptual reversals from perceptual stability. For EEG sweeps classified as either map, distributed inverse solutions were computed and statistically compared. This yielded activity confined to a region in right inferior parietal cortex that was significantly more active before a perceptual reversal. In contrast, no significant topographic differences of the evoked potentials elicited by stable vs. reversed Necker cubes were found. This indicates that prestimulus activity in right inferior parietal cortex is associated with the perceptual change.

Electrophysiological correlates of affective blindsight.

An EEG investigation was carried out in a patient with complete cortical blindness who presented affective blindsight, i.e. who performed above chance when asked to guess the emotional expressions on a series of faces. To uncover the electrophysiological mechanisms involved in this phenomenon we combined multivariate pattern recognition (MPR) with local field potential estimates provided by electric source imaging (ELECTRA). All faces, including neutral faces, elicited distinctive oscillatory EEG patterns that were correctly identified by the MPR algorithm as belonging to the class of facial expressions actually presented. Consequently, neural responses in this patient are not restricted to emotionally laden faces. Earliest non-specific differences between faces occur from 70 ms onwards in the superior temporal polysensory area (STP). Emotion-specific responses were found after 120 ms in the right anterior areas with right amygdala activation observed only later (approximately 200 ms). Thus, affective blindsight might be mediated by subcortical afferents to temporal areas as suggested in some studies involving non-emotional stimuli. The early activation of the STP in the patient constitutes evidence for fast activation of higher order visual areas in humans despite bilateral V1 destruction. In addition, the absence of awareness of any visual experience in this patient suggests that neither the extrastriate visual areas, nor the prefrontal cortex activation alone are sufficient for conscious perception, which might require recurrent processing within a network of several cerebral areas including V1.

Anomalous brain dominance and the immune system: do left-handers have specific immunological patterns?

Geschwind and Behan (1982) and Geschwind and Galaburda (1985a, 1985b, 1985c) suggested a correlation between brain laterality and immune disorders. To test whether this hypothesis holds true not only for the frequency of immune diseases and circulating autoantibodies, but extends also to cellular immunity, we examined the association between handedness and markers of cellular immunity. Twenty-seven left-handed and 37 right-handed subjects were serologically screened for cellular parameters and 22 left-handed subjects were typed for human leukocyte antigen (HLA). When compared to the right-handers, the left-handed group showed a significant decrease in the inflammatory cell types CD3(+) T cells (total T cells), CD4(+) T cells (T-helper cells), and HLA-Dr (MHC-II, antigen-presenting cells) as well as in the CD19(+) cells (B cells) and CD16/CD57(+) cells (natural killer cells). We assume a relationship exists between cerebral hemispheric specialisation and the immune system not only for humoral but also for cellular immunity, and we discuss the role of the major histocompatibility complex in neurological and immunological development.

Levetiracetam accumulation in renal failure causing myoclonic encephalopathy with triphasic waves.

Triphasic waves are seen in the electro-encephalogram of adult patients with toxic-metabolic encephalopathies of various origins. Levetiracetam is a broad spectrum anti-epileptic drug with renal elimination and no hepatic metabolism. We describe the case of encephalopathy with triphasic waves concomitant with levetiracetam accumulation in a patient with chronic renal failure. The condition was reversible after down-titration of levetiracetam with no change of the renal function. Other causes of metabolic encephalopathy were excluded. Moreover, this patient suffered from a probable cortical myoclonus that relapsed after cessation of the drug but was well controlled by a low dosage adapted to the renal failure. In cases of metabolic encephalopathy with triphasic waves in a patient with renal failure taking levetiracetam, it is important to exclude toxic accumulation of levetiracetam among other causes.

Perceptual distortion in homonymous paracentral scotomas.

BACKGROUND: Cortical remapping after peripheral or central visual deafferentation alters visual perception, but it is unclear whether such a phenomenon impinges on areas remote from a scotoma. To investigate this question, we studied variations of perceptual spatial distortion in the visual field of patients with homonymous paracentral scotoma. METHODS: Two patients with right inferior homonymous paracentral scotoma were asked to describe their perception of a series of figures showing two isometric vertical lines symmetrically located on either side of a fixation point. In each figure, the fixation point varied by steps of 2 degrees along a hypothetical vertical line equidistant between the test lines. The lines subtended 20 degrees of visual angle, and the right line passed through the scotoma in both cases. Time for spatial distortion to manifest was recorded. RESULTS: Both subjects reported that the right line was perceived as shorter than the left one. The line shortening varied in magnitude with the distance of the fixation point from the end of the line and was more pronounced when the distance increased. Moreover, perceptual line shortening appeared 5-10 seconds after steady fixation, but values of shortening varied during the following 10 seconds. In addition, the right line appeared uninterrupted or slightly blurred in the scotoma region. CONCLUSIONS: These observations reflect long-range cortical reorganization after brain damage. Larger receptive fields in the periphery of the visual map could explain why perceptual shortening is more pronounced with increased eccentricity.

Impaired visual search with paradoxically increased facilitation by emotional features after unilateral pulvinar damage.

Posterior thalamic pulvinar nuclei have been implicated in different aspects of spatial attention, but their exact role in humans remain unclear. Most neuropsychological studies of attention deficits after pulvinar lesion have concerned single patients or small samples. Here we examined a group of 13 patients with focal damage to posterior thalamus on a visual search task with faces, allowing us to test several hypotheses concerning pulvinar function in controlling attention to visually salient or emotionally significant stimuli. Our results identified two subgroups of thalamic patients with distinct patterns of attentional responsiveness to emotional and colour features in face targets. One group with lesions located in anterior and ventral portions of thalamus showed intact performance, with a normal facilitation of visual search for faces with emotional (fearful or happy) expressions on both side of space, similar to healthy controls. By contrast, a second group showed a slower and poorer detection of face targets, most severe for neutral faces, but with a paradoxically enhanced facilitation by both colour and emotional features. This second group had lesions centred on the pulvinar, involving mainly the dorso-medial sectors in patients showing enhanced effects of colour features, but extending to more dorso-lateral sectors in those with enhanced effects of emotional features. These findings reveal that pulvinar nuclei are not critical for orienting attention to emotionally or visually salient features, but instead provide new evidence in support of previous hypotheses suggesting an important role in controlling attention in visual scenes with distracting information.

Cortical motion deafness.

The extent to which the auditory system, like the visual system, processes spatial stimulus characteristics such as location and motion in separate specialized neuronal modules or in one homogeneously distributed network is unresolved. Here we present a patient with a selective deficit for the perception and discrimination of auditory motion following resection of the right anterior temporal lobe and the right posterior superior temporal gyrus (STG). Analysis of stimulus identity and location within the auditory scene remained intact. In addition, intracranial auditory evoked potentials, recorded preoperatively, revealed motion-specific responses selectively over the resected right posterior STG, and electrical cortical stimulation of this region was experienced by the patient as incoming moving sounds. Collectively, these data present a patient with cortical motion deafness, providing evidence that cortical processing of auditory motion is performed in a specialized module within the posterior STG.

Hemineglect: take a look at the back space.

Visual hemineglect, the failure to explore the half of space, real or imagined, contralateral to a cerebral lesion with respect to body or head, can be seen as an illustration of the brain's Euclidean representation of the left/right axis. Here we present two patients with left-sided neglect, in whom only the left hemispace in front of an imagined and/or real body position was inaccessible, but the space behind them remained fully represented. These observations suggest that of the three Euclidean dimensions (up/down, left/right, and front/back), at least the latter two are modularly and separately represented in the human brain.

Compulsive singing: another aspect of punding in Parkinson's disease.

We report on two patients with advanced Parkinson's disease who were exhibiting a peculiar and stereotyped behavior characterized by an irrepressible need to sing compulsively when under high-dose dopamine replacement therapy. Sharing many features with punding, this singing behavior is proposed as a distinct manifestation of the dopamine dysregulation syndrome in Parkinson's disease.