An fMRI study of visual hemifield integration and cerebral lateralization.

The human brain integrates hemifield-split visual information via interhemispheric transfer. The degree to which neural circuits involved in this process behave differently during word recognition as compared to object recognition is not known. Evidence from neuroimaging (fMRI) suggests that interhemispheric transfer during word viewing converges in the left hemisphere, in two distinct brain areas, an "occipital word form area" (OWFA) and a more anterior occipitotemporal "visual word form area" (VWFA). We used a novel fMRI half-field repetition technique to test whether or not these areas also integrate nonverbal hemifield-split string stimuli of similar visual complexity. We found that the fMRI responses of both the OWFA and VWFA while viewing nonverbal stimuli were strikingly different than those measured during word viewing, especially with respect to half-stimulus changes restricted to a single hemifield. We conclude that normal reading relies on left-lateralized neural mechanisms, which integrate hemifield-split visual information for words but not for nonverbal stimuli.

Quantitative evaluation of vision-related and health-related quality of life after endoscopic transsphenoidal surgery for pituitary adenoma.

OBJECTIVE Endoscopic resection of pituitary adenomas has been reported to improve vision function in up to 80%-90% of patients with visual impairment due to these adenomas. It is unclear how these reported rates translate into improvement in visual outcomes and general health as perceived by the patients. The authors evaluated self-assessed health-related quality of life (HR-QOL) and vision-related QOL (VR-QOL) in patients before and after endoscopic resection of pituitary adenomas. METHODS The authors prospectively collected data from 50 patients who underwent endoscopic resection of pituitary adenomas. This cohort included 32 patients (64%) with visual impairment preoperatively. Twenty-seven patients (54%) had pituitary dysfunction, including 17 (34%) with hormone-producing tumors. Patients completed the National Eye Institute Visual Functioning Questionnaire and the 36-Item Short Form Health Survey preoperatively and 6 weeks and 6 months after surgery. RESULTS Patients with preoperative visual impairment reported a significant impact of this condition on VR-QOL preoperatively, including general vision, near activities, and peripheral vision; they also noted vision-specific impacts on mental health, role difficulties, dependency, and driving. After endoscopic resection of adenomas, patients reported improvement across all these categories 6 weeks postoperatively, and this improvement was maintained by 6 months postoperatively. Patients with preoperative pituitary dysfunction, including hormone-producing tumors, perceived their general health and physical function as poorer, with some of these patients reporting improvement in perceived general health after the endoscopic surgery. All patients noted that their ability to work or perform activities of daily living was transiently reduced 6 weeks postoperatively, followed by significant improvement by 6 months after the surgery. CONCLUSIONS Both VR-QOL and patient's perceptions of their ability to do work and perform other daily activities as a result of their physical health significantly improved by 6 months after endoscopic resection of pituitary adenoma. The use of multidimensional QOL questionnaires provides a precise assessment of perceived outcomes after endoscopic surgery.

Visual Cortical Representation of Whole Words and Hemifield-split Word Parts.

Reading requires the neural integration of visual word form information that is split between our retinal hemifields. We examined multiple visual cortical areas involved in this process by measuring fMRI responses while observers viewed words that changed or repeated in one or both hemifields. We were specifically interested in identifying brain areas that exhibit decreased fMRI responses as a result of repeated versus changing visual word form information in each visual hemifield. Our method yielded highly significant effects of word repetition in a previously reported visual word form area (VWFA) in occipitotemporal cortex, which represents hemifield-split words as whole units. We also identified a more posterior occipital word form area (OWFA), which represents word form information in the right and left hemifields independently and is thus both functionally and anatomically distinct from the VWFA. Both the VWFA and the OWFA were left-lateralized in our study and strikingly symmetric in anatomical location relative to known face-selective visual cortical areas in the right hemisphere. Our findings are consistent with the observation that category-selective visual areas come in pairs and support the view that neural mechanisms in left visual cortex--especially those that evolved to support the visual processing of faces--are developmentally malleable and become incorporated into a left-lateralized visual word form network that supports rapid word recognition and reading.

Double representation of the wrist and elbow in human motor cortex.

Movements of the fingers, hand and arm involve overlapping neural representations in primary motor cortex (M1). Monkey M1 exhibits a core-surround organisation in which cortical representation of the hand and fingers is surrounded by representations of the wrist, elbow and shoulder. A potentially homologous organisation in human M1 has only been observed in a single study, a functional MRI (fMRI) study by [J.D. Meier, T.N. Aflalo, S. Kastner & M.S. Graziano.(2008) J Neurophysiol, 100(4), 1800-1812]. The results of their study suggested a double representation of the wrist in human M1, an unprecedented finding. Our purpose was to document and simultaneously provide evidence that would extend the presence of double representation of the wrist to that of the elbow. Using fMRI, we observed somatotopic maps in M1 and the supplementary motor area (SMA), the only other cortical area that showed robust within-limb somatotopy during self-timed finger, wrist and elbow movements. We observed double wrist and elbow representation that bracketed finger fMRI responses in M1 and the SMA. Our results show that the cortical locations of these double representations are well predicted by local cortical anatomy. Double representation of the wrist and elbow is important because it violates the traditional somatotopic progression in M1 but it is consistent with the representation of synergistic movements involving adjacent effectors.