Brain networks in posterior cortical atrophy: A single case tractography study and literature review

Posterior cortical atrophy (PCA) is rare neurodegenerative dementia, clinically characterized by a progressive decline in higher-visual object and space processing. After a brief review of the literature on the neuroimaging in PCA, here we present a study of the brain structural connectivity in a patient with PCA and progressive isolated visual and visuo-motor signs. Clinical and cognitive data were acquired in a 58-years-old patient (woman, right-handed, disease duration 18 months). Brain structural and diffusion tensor (DT) Magnetic Resonance Imaging (MRI) were obtained. A voxel-based morphometry (VBM) study was performed to explore the pattern of gray matter (GM) atrophy, and a fully automatic segmentation was assessed to obtain the hippocampal volumes. DT MRI-based tractography was used to assess the integrity of long-range white matter (WM) pathways in the patient and in six sex- and age-matched healthy subjects. This PCA patient had a clinical syndrome characterized by left visual neglect, optic ataxia, and left limb apraxia, as well as mild visuo-spatial episodic memory impairment. VBM study showed bilateral posterior GM atrophy with right predominance; DT MRI tractography demonstrated WM damage to the right hemisphere only, including the superior and inferior longitudinal fasciculi and the inferior fronto-occipital fasciculus, as compared to age-matched controls. The homologous left-hemisphere tracts were spared. No difference was found between left and right hippocampal volumes. These data suggest that selective visuo-spatial deficits typical of PCA might not result from cortical damage alone, but by a right-lateralized network-level dysfunction including WM damage along the major visual pathways

The Predictive Nature of Pseudoneglect for Visual Neglect: Evidence from Parietal Theta Burst Stimulation

Following parietal damage most patients with visual neglect bisect horizontal lines significantly away from the true centre. Neurologically intact individuals also misbisect lines; a phenomenon referred to as ‘pseudoneglect’. In this study we examined the relationship between neglect and pseudoneglect by testing how patterns of pre-existing visuospatial asymmetry predict asymmetry caused by parietal interference. Twenty-four participants completed line bisection and Landmark tasks before receiving continuous theta burst stimulation to the left or right angular gyrus. Results showed that a pre-existing pattern of left pseudoneglect (i.e. right bias), but not right pseudoneglect, predicts left neglect-like behaviour during line bisection following right parietal cTBS. This correlation is consistent with the view that neglect and pseudoneglect arise via a common or linked neural mechanism