Blindness, Cortical

失明,皮质
  • 文章类型: Letter
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  • 文章类型: Case Reports
    背景:皮质视觉障碍(CVI)是一种可证实的视觉功能障碍,不能归因于前视觉通路的障碍或任何潜在的共同发生的眼部损害。鉴于对CVI引起的视力障碍的最有效干预措施的知识有限,本病例报告为CVI患者成功实施抗弱视治疗提供了有价值的见解.
    方法:本病例报告介绍了一名5岁女孩,继发于缺氧缺血性损伤的CVI,导致视力障碍,消化不良,和异常视觉诱发电位测试。这个女孩没有患有弱视,没有相关屈光不正或斜视的证据,所以视觉通路受损是她视觉缺陷的原因。然而,患者接受了抗弱视治疗,治疗12个月后视力显著改善.的改进,由于视觉刺激,是由于通过更好地使用受损的视觉通路而获得了良好的功能恢复。治疗包括处方矫正眼镜和对较好的眼睛进行二次遮挡4个月,又延长了4个月,导致视力进一步提高。
    结论:病例报告显示,即使是轻微的屈光不正,实施抗弱视治疗也能显著改善CVI患儿的视力,即使没有共存的弱视。它还强调了CVI儿童早期干预和多学科康复的重要性,专注于运动和认知技能。此外,它强调需要进一步研究以建立基于证据的实践标准来改善CVI儿童的视力.
    BACKGROUND: Cortical visual impairment (CVI) is a verifiable visual dysfunction that cannot be attributed to disorders of the anterior visual pathways or any potentially co-occurring ocular impairment. Given the limited knowledge on the most effective interventions for visual impairment resulting from CVI, this case report provides valuable insights into an example of successful implementation of anti-amblyopia therapy in a patient with CVI.
    METHODS: This case report presents a 5-year-old girl with CVI secondary to hypoxic-ischemic injury, resulting in visual impairment, dyspraxia, and abnormal visual evoked potential testing. The girl did not suffer from amblyopia, there was no evidence of relevant refractive errors or strabismus, so visual pathway damage was the cause of her visual deficit. Nevertheless, the patient underwent anti-amblyopia therapy and showed significant improvement in visual acuity after 12 months of treatment. The improvement, resulting from visual stimulation, was due to a good functional recovery by a better usage of the damaged visual pathways. The therapy included prescribing corrective glasses and implementing secondary occlusion of the better eye for 4 months, which was protracted for another 4 months, leading to further improvements in visual acuity.
    CONCLUSIONS: The case report shows that addressing even minor refractive errors and implementing anti-amblyopia therapy can significantly improve vision in children with CVI, even without co-existing amblyopia. It also highlights the importance of early intervention and multidisciplinary rehabilitation in children with CVI, focusing on motor and cognitive skills. Additionally, it emphasizes the need for further research to establish evidence-based practice standards for improving vision in children with CVI.
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  • 文章类型: Case Reports
    经皮椎体成形术后的许多并发症但皮质盲很少报道。这里,我们描述了一例经皮椎体成形术后出现皮质盲的病例.我们还回顾了文献,以找到这种并发症的可能原因及其治疗方法。
    病例报告和文献复习。
    一名71岁女性在经皮椎体成形术后出现皮质盲。她出现头晕,恶心,出汗,血压变化,以及手术过程中的视力丧失。MRI证实双侧脑梗死。患者经保守治疗痊愈。
    经皮椎体成形术,虽然有用,有罕见的皮质盲风险.外科医生的意识对于告知患者这种潜在的并发症至关重要。
    Many complications but cortical blindness after percutaneous vertebroplasty has been rarely reported. Here, we describe a case who developed cortical blindness after percutaneous vertebroplasty. We also reviewed the literature to find the possible causes of this complication and its treatment.
    Case report and literature review.
    A 71-year-old woman experienced cortical blindness after percutaneous vertebroplast. She developed dizziness, nausea, sweating, blood pressure changes, and vision loss during the procedure. MRI confirmed bilateral cerebral infarctions. The patient recovered with conservative treatment.
    Percutaneous vertebroplasty, though helpful, carries a rare risk of cortical blindness. Surgeon awareness is crucial for informing patients of this potential complication.
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  • 文章类型: Journal Article
    目的:根据克里克和科赫在1995年提出的开创性假设,人们不知道初级视觉皮层(V1)中的神经活动,因为该区域与前额叶皮层(PFC)缺乏相互联系。
    方法:我们在此提供了一个非常罕见形式的皮质盲患者的神经心理学例证:腹侧和背侧皮质通路双侧损伤,而V1区域部分保留。
    结果:视觉刺激逃避了有意识的感知,但仍然激活了功能上与PFC断开的V1区域。
    结论:这些结果与PFC在视觉意识中的因果作用的假设一致。
    OBJECTIVE: According to a seminal hypothesis stated by Crick and Koch in 1995, one is not aware of neural activity in primary visual cortex (V1) because this region lacks reciprocal connections with prefrontal cortex (PFC).
    METHODS: We provide here a neuropsychological illustration of this hypothesis in a patient with a very rare form of cortical blindness: ventral and dorsal cortical pathways were lesioned bilaterally while V1 areas were partially preserved.
    RESULTS: Visual stimuli escaped conscious perception but still activated V1 regions that were functionally disconnected from PFC.
    CONCLUSIONS: These results are consistent with the hypothesis of a causal role of PFC in visual awareness.
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  • 文章类型: Journal Article
    背景:脑视力障碍(CVI)是发达国家儿童视力障碍的最常见形式。CVI可以由许多遗传或获得性原因引起,但迄今为止在遗传性疾病背景下对CVI的研究有限.
    方法:我们在DECIPHER数据库和100000GenomesProject(100KGP)中对CVI参与者的基因型和表型数据进行了回顾性分析。
    结果:在两个队列中确定了158名患有CVI的个体。在这个群体中,在173个基因中发现了致病性或可能的致病性序列变异.这些基因中的25个已经与CVI有已知的关联,而其余148个是该表型的候选基因。来自DECIPHER和100KGP的CVI基因集的基因本体论分析表明,CVI与其他神经发育表型具有相似程度的遗传异质性。与离子通道和受体功能上的遗传变异密切相关。具有单基因紊乱和CVI的个体比具有单基因紊乱但不具有CVI的个体具有更高的癫痫和严重神经残疾的频率。
    结论:这项研究支持对患有CVI以及其他神经发育困难的个体进行基因检测。它还支持对与CVI相关的遗传诊断的个体进行眼科筛查。进一步的研究可以详细说明特定遗传疾病之间的联系,视觉成熟和更广泛的神经发育特征。
    BACKGROUND: Cerebral visual impairment (CVI) is the most common form of paediatric visual impairment in developed countries. CVI can arise from a host of genetic or acquired causes, but there has been limited research to date on CVI in the context of genetic disorders.
    METHODS: We carried out a retrospective analysis of genotypic and phenotypic data for participants with CVI within the DECIPHER database and 100 000 Genomes Project (100KGP).
    RESULTS: 158 individuals with CVI were identified across both cohorts. Within this group, pathogenic or likely pathogenic sequence variants in 173 genes were identified. 25 of these genes already have known associations with CVI, while the remaining 148 are candidate genes for this phenotype. Gene ontology analysis of the CVI gene sets from both DECIPHER and 100KGP suggests that CVI has a similar degree of genetic heterogeneity to other neurodevelopmental phenotypes, and a strong association with genetic variants converging on ion channels and receptor functions. Individuals with a monogenic disorder and CVI have a higher frequency of epilepsies and severe neurodisability than individuals with a monogenic disorder but not CVI.
    CONCLUSIONS: This study supports the availability of genetic testing for individuals with CVI alongside other neurodevelopmental difficulties. It also supports the availability of ophthalmological screening for individuals with genetic diagnoses linked to CVI. Further studies could elaborate on the links between specific genetic disorders, visual maturation and broader neurodevelopmental characteristics.
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  • 文章类型: Journal Article
    皮质盲患者存在无意识的视觉触发行为(例如,同义偏盲)已经得到了充分的证明,并且已经对这种现象的神经基础进行了彻底的研究。然而,到目前为止,尚未考虑将两个半球之间的串扰作为无意识或部分意识视觉的可能机制。因此,这项研究的目的是评估call体(CC)的结构和功能特性之间的关系,如概率纤维束成像(PT)所示,偏盲患者在盲区的行为检测/辨别表现和知觉意识水平。12名患者用黑白视觉方波光栅在两项任务中进行了测试,一个任务是运动,另一个任务是定向。刺激被横向化到一个半区域,无论是完整的还是盲目的。对MRI数据进行PT分析,以提取沿CC的纤维特性(genu,身体,和splenium)。与没有脑损伤的对照组相比,在所研究的所有3个CC切片中,患者的FA值均较低.对于完整的半球,我们发现PT值与视觉检测/辨别准确性之间存在显着相关性。对于盲半场,感知意识的水平与运动任务中所有三个CC部分的PT值相关。重要的是,上述患者与患者之间在所有三个CC切片中也发现了显着差异机会检测/辨别表现,而在有和没有知觉意识的患者之间发现了Genu的差异。总的来说,我们的研究提供了证据,表明CC纤维的特性与无意识刺激检测/辨别的存在以及对盲区的刺激呈现的感知意识的暗示有关。这些结果强调了受损半球和健康半球之间信息交换的重要性,以便可能从偏盲中部分或完全恢复。
    The existence of unconscious visually triggered behavior in patients with cortical blindness (e.g., homonymous hemianopia) has been amply demonstrated and the neural bases of this phenomenon have been thoroughly studied. However, a crosstalk between the two hemispheres as a possible mechanism of unconscious or partially conscious vision has not been so far considered. Thus, the aim of this study was to assess the relationship between structural and functional properties of the corpus callosum (CC), as shown by probabilistic tractography (PT), behavioral detection/discrimination performance and level of perceptual awareness in the blind field of patients with hemianopia. Twelve patients were tested in two tasks with black-and-white visual square-wave gratings, one task of movement and the other of orientation. The stimuli were lateralized to one hemifield either intact or blind. A PT analysis was carried out on MRI data to extract fiber properties along the CC (genu, body, and splenium). Compared with a control group of participants without brain damage, patients showed lower FA values in all three CC sections studied. For the intact hemifield we found a significant correlation between PT values and visual detection/discrimination accuracy. For the blind hemifield the level of perceptual awareness correlated with PT values for all three CC sections in the movement task. Importantly, significant differences in all three CC sections were found also between patients with above-vs. chance detection/discrimination performance while differences in the genu were found between patients with and without perceptual awareness. Overall, our study provides evidence that the properties of CC fibers are related to the presence of unconscious stimulus detection/discrimination and to hints of perceptual awareness for stimulus presentation to the blind hemifield. These results underline the importance of information exchange between the damaged and the healthy hemisphere for possible partial or full recovery from hemianopia.
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  • 文章类型: Case Reports
    视觉性失认症,在枕叶损伤的背景下,与虚构和皮质盲相关,被称为安东综合症。患有这种综合征的患者强烈否认他们的视力丧失,并弥补视力丧失和记忆障碍。在这篇文章中,我们介绍了一个与安东综合征有相似之处的病人,然而,临床表现有几个差异。双额叶脑损伤,双侧摘除,情感冷漠全身性失认症,视力恢复的信念标志着安东综合征与临床的明显差异。将这些发现与安东综合征区分开来将有助于职业治疗师,神经心理学家,语言病理学家,物理治疗师,和医生在评估额叶脑损伤与全部和部分视力丧失时。此病例表明,在没有枕叶功能障碍或皮质盲的情况下,可以发生视觉失语症和虚构。
    Visual anosognosia, associated with confabulations and cortical blindness in the context of occipital lobe injury, is known as Anton syndrome. Patients with this syndrome strongly deny their vision loss and confabulate to compensate for both visual loss and memory impairments. In this article, we present a case of a patient with some similarities to Anton syndrome, however, with several differences in clinical presentation. Bifrontal brain injury, bilateral enucleation, affective indifference (anosodiaphoria), generalized anosognosia, and the conviction that vision will resume mark clear clinical differences with Anton syndrome. Differentiating these findings from Anton syndrome will help occupational therapists, neuropsychologists, speech-language pathologists, physical therapists, and physicians when assessing frontal lobe brain injury with total and partial visual loss. This case demonstrates that visual anosognosia and confabulations can occur without occipital lobe dysfunction or cortical blindness.
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  • 文章类型: Case Reports
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  • 文章类型: Journal Article
    背景:造影剂诱导的神经毒性(CIN)是血管内手术后越来越多的并发症。它仍然是一个相对未探索的临床实体,我们试图描述临床医生对CIN的观点,以及确定知识差距,并为未来的研究提供方向。
    方法:一项在线调查分发给澳大利亚和新西兰神经放射学学会的成员,以及几家澳大利亚三级医院。与临床接触CIN相关的问题,诊断,探讨了管理和病理生理学。对调查答复进行了描述性分析,统计分析采用卡方检验和Fisher精确检验。
    结果:共记录了95个调查响应(26.8%的响应率)。只有28.4%的受访者对诊断CIN感到满意,在独立管理CIN患者中感到舒适的人甚至更少(24.2%)。根据临床医生的意见,包括意识障碍和皮质盲在内的症状被认为与CIN最相关,而实质水肿和皮质增强的放射学发现被认为是CIN的最具指示性的。大多数临床医生认为需要进一步的病理生理学调查(86.3%)。诊断(83.2%),和治疗(82.1%)。
    结论:CIN是血管内手术后的一种鲜为人知的并发症。临床理解上的巨大差距是显而易见的,进一步的调查对于改善诊断和管理至关重要。
    BACKGROUND: Contrast-induced Neurotoxicity (CIN) is an increasingly recognised complication following endovascular procedures. It remains a relatively unexplored clinical entity, and we sought to characterise clinician perspectives towards CIN, as well as identify gaps in knowledge and provide directions for future research.
    METHODS: An online survey was distributed to members of the Australian and New Zealand Society of Neuroradiology, as well as several Australian tertiary hospitals. Questions related to clinical exposure to CIN, diagnosis, management and pathophysiology were explored. Descriptive analysis was conducted on survey responses, and statistical analysis was performed using Chi-square and Fisher\'s exact test as appropriate.
    RESULTS: A total of 95 survey responses were recorded (26.8% response rate). Only 28.4% of respondents were comfortable in diagnosing CIN, and even fewer (24.2%) were comfortable in independently managing CIN patients. Based on clinician opinion, symptoms including impaired consciousness and cortical blindness were thought to be most associated with CIN, whilst the radiological findings of parenchymal oedema and cortical enhancement were considered to be most indicative of CIN. Most clinicians agreed that further investigation is required related to pathophysiology (86.3%), diagnosis (83.2%), and treatment (82.1%).
    CONCLUSIONS: CIN is a poorly understood complication following endovascular procedures. Significant gaps in clinical understanding are evident, and further investigation is vital to improve diagnosis and management.
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  • 文章类型: Journal Article
    大脑视觉障碍引起了神经学家的极大兴趣,眼科医生,神经科学家。本文讨论了与皮质盲有关的复杂或部分变种。它们是著名临床综合征的迷人字母,近乎神经学,眼科,甚至是精神病学.除了经典的病变证据外,最近的功能成像和实验研究还为认知视觉组织提供了进一步的知识。
    Cerebral visual impairments have been of great interest to neurologists, ophthalmologists, and neuroscientists. Complicated or partial varieties related to cortical blindness are discussed in this review. They are a fascinating alphabet of eponymic clinical syndromes, bordering neurology, ophthalmology, and even psychiatry. Recent functional imaging and experimental studies have contributed further knowledge of cognitive visual organization in addition to the classical lesion evidence.
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