Cases reported "Perceptual Disorders"

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21/46. A deficit in discriminating gaze direction in a case with right superior temporal gyrus lesion.

    The superior temporal sulcus (STS) region is well recognized as being heavily involved in detecting and discriminating gaze. Lesions confined to this area are quite rare in humans, and so the research has mainly depended on animal studies and functional neuroimaging in normal human subjects. We report one such rare case, a 54-year-old Japanese female with a possible congenital s anomaly who, after a cerebral hemorrhage, demonstrated a lesion almost completely confined to the entire right superior temporal gyrus (STG). In the subacute phase, the patient showed evidence of left hemispatial neglect, from which she gradually recovered. In the chronic phase, she showed a puzzling difficulty in obtaining eye-contact. We have conducted, in conjunction with conventional neuropsychological evaluations, experimental assessment of her ability in gaze cognition. Her performance on neuropsychological testing demonstrated no compromise in intellect, memory, or language skills, and a close-to-full recovery from neglect. On gaze cognition experiments, she was repeatedly shown to perceive left gaze as straight, and to a lesser degree, straight gaze as right. We suggest that the function of the STG in detecting gaze, together with the directional information it receives from earlier visual areas, may be associated, when damaged, with this deficit in detecting contra-directional gaze. We have demonstrated for the first time that a single circumscribed lesion to the STG results in both gaze processing deficit and concurrent aberrant gaze behavior of the victim herself, implicating a mechanism within the STG as an interface between gaze of others and gaze of self.
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22/46. Specific retinotopically based magnocellular impairment in a patient with medial visual dorsal stream damage.

    We report here retinotopically based magnocellular deficits in a patient with a unilateral parieto-occipital lesion. We applied convergent methodologies to study his dorsal stream processing, using psychophysics as well as structural and functional imaging. Using standard perimetry we found deficits involving the periphery of the left inferior quadrant abutting the horizontal meridian, suggesting damage of dorsal retinotopic representations beyond V1. Retinotopic damage was much more extensive when probed with frequency-doubling based contrast sensitivity measurements, which isolate processing within the magnocellular pathway: sensitivity losses now encroached on the visual central representation and did not respect the horizontal meridian, suggesting further damage to dorsal stream retinotopic areas that contain full hemi-field representations, such as human V3A or V6. Functional imaging revealed normal responses of human MT to motion contrast. Taken together, these findings are consistent with a recent proposal of two distinct magnocellular dorsal stream pathways: a latero-dorsal pathway passing to MT and concerned with the processing of coherent motion, and a medio-dorsal pathway that routes information from V3A to the human homologue of V6. Anatomical evidence was consistent with sparing of the latero-dorsal pathway in our patient, and was corroborated by his normal performance in speed, direction discrimination and motion coherence tasks with 2D and 3D objects. His pattern of dysfunction suggests damage only to the medio-dorsal pathway, an inference that is consistent with structural imaging data, which revealed a lesion encompassing the right parieto-occipital sulcus.
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23/46. Left hemispatial visual neglect associated with a combined right occipital and splenial lesion: another disconnection syndrome.

    Damage to the left occipital lobe and the splenium or forceps major is often associated with pure alexia, thought to be an occipital-temporoparietal disconnection syndrome. A patient with the parallel lesion, a combined right occipital and splenial lesion, showed severe left-sided visual spatial neglect, but no significant neglect in other sensory modalities. This visual neglect might be related to a disconnection between the visual information processed by the left occipital lobe and the right posterior temporal-inferior parietal areas that mediate attention in the left hemispace.
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24/46. letter form as a constraint for errors in neglect dyslexia and letter position dyslexia.

    Does letter-form constrain errors in peripheral dyslexia? In Hebrew, 5 of the 22 letters have two different letter forms, one is used only when the letter occurs in word-final position, the other form is used in initial and middle positions. Is the information on final-forms encoded in the letter identity information and used for word identification, or is it discarded? The current research explored this question through the effect of final vs. non final letter form on the error pattern in neglect dyslexia (neglexia) and letter position dyslexia (LPD). Left word-based neglexia results in errors of omission, substitution and addition of letters in the left side of words, which in Hebrew is the end of the word. We examined whether final letter form blocks the addition of letters to the end of the word and whether omissions of letters after letters in non-final form are avoided. The predominant error type in LPD is migration of letters within words. We tested whether migrations also occur when they cause form change of either final-form letters that move to middle position or middle-form letters that move to final position. These questions were assessed in both acquired and developmental neglexia and LPD. The results indicated a strong effect of final letter-form on acquired neglexia and on acquired and developmental LPD, which almost completely prevented form-changing errors. This effect was not found in developmental neglexia, where words that end in final-form letters were actually more impaired than other words, probably because final-form letters appear only on the neglected side of the word for Hebrew-reading children with left developmental neglexia. These data show that early visuo-orthographic analysis is sensitive to final letter form and that final letter form constrains errors in peripheral dyslexia.
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25/46. Right unilateral jargonagraphia as a symptom of callosal disconnection.

    We report the case of a right-handed patient who exhibited right unilateral jargonagraphia after a traumatic callosal hemorrhage. The lesions involved the entire corpus callosum, except for the lower part of the genu and the splenium. The patient's right unilateral jargonagraphia was characterized by neologisms and perseveration in kanji and kana, and was more prominent in kana than kanji. The jargonagraphia was similar to that observed in crossed aphasia, except that agraphia occurred only with the right hand. The patient also showed right unilateral tactile anomia and right tactile alexia, along with right-ear extinction on a dichotic listening test for verbal stimuli, which suggested that language function was lateralized to the right hemisphere. Since this patient had learned to write with his right hand, kinesthetic images of characters were thought to be formed and stored dominantly in the left hemisphere. We suggest that the callosal lesions disturbed the interhemispheric transfer of information for the dual-route procedures for writing in the right hemisphere, allowing the kinesthetic images of characters stored in the left hemisphere to be processed freely, resulting in the right unilateral jargonagraphia. At least two factors seem to explain that kana was more defective than kanji. First, writing in kana, which is assumed to be processed mainly via a sub-word phoneme to grapheme conversion route, might depend more strongly on lateralized linguistic processing than writing in kanji. Second, kanji, which represent meaning as well as phonology, with much more complicated graphic patterns than kana, are assumed to be processed in both hemispheres.
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26/46. The influence of visual and nonvisual attributes in visual object identification.

    To elucidate the role of visual and nonvisual attribute knowledge on visual object identification, we present data from three patients, each with visual object identification impairments as a result of different etiologies. patients were shown novel computer-generated shapes paired with different labels referencing known entities. On test trials they were shown the novel shapes alone and had to identify them by generating the label with which they were formerly paired. In all conditions the same triad of computer-generated shapes were used. In one condition, the labels (banjo, guitar, violin) referenced entities that were both visually similar and similar in terms of their nonvisual attributes within semantics. In separate conditions we used labels (e.g., spike, straw, pencil or snorkel, cane, crowbar) that referenced entities that were similar in terms of their visual attributes but were dissimilar in terms of their nonvisual attributes. The results revealed that nonvisual attribute information profoundly influenced visual object identification. Our patients performed significantly better when attempting to identify shape triads whose labels referenced objects with distinct nonvisual attributes versus shape triads whose labels referenced objects with similar nonvisual attributes. We conclude that the nonvisual aspects of meaning must be taken into consideration when assessing visual object identification impairments.
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27/46. Gaze but not arrows: a dissociative impairment after right superior temporal gyrus damage.

    Superior temporal sulcus (STS) activation has consistently been demonstrated in the normal brain when viewing eyes, and thus this area is implicated as a gaze processing region in humans. In a recent report, we have presented a case, M.J., with a well-circumscribed lesion to the right superior temporal gyrus (STG), who demonstrated impaired discrimination of gaze direction. In the aim to make distinct whether this impairment is unique to gaze, we have applied a spatial cueing paradigm established by Kingstone and colleagues. In our experiment, pictorial gaze and symmetrical arrows were centrally presented as non-predictive, spatial cues in detecting peripheral targets. Fifteen normal subjects and M.J. participated in the experiment. In concordance with previous reports, controls demonstrated a significant facilitation of reaction times in detecting targets cued by congruent gaze/arrows, compared with incongruent cues. In striking contrast, M.J. showed no such congruency advantage for gaze, in the face of a normal congruency advantage for arrows. We have demonstrated that a circumscribed lesion to the right STG impairs the ability to utilize biological directional information such as gaze, but leaves the non-biological counterpart (arrows) intact. This dissociation implies that indeed, the STS specializes in processing gaze.
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28/46. Spatial representation of words in the brain implied by studies of a unilateral neglect patient.

    reading and writing require access to stored knowledge about the spelling of words. Presumably, we recognize chair but not chare or chiar as a word of English, and similarly would write 'chair' but not 'chare' or 'chiar', because we access orthographic representations that specify the identity and the order of the graphemes (abstract letter representations) that comprise the spelling of words. Thus, a fundamental problem concerns the content and structure of the hypothesized orthographic representations, and how information about grapheme order is represented and processed. We present evidence from a brain-damaged patient (N.G.) with unilateral neglect that this information is coded spatially. Unilateral neglect is a disorder clinically characterized by the inability to perceive or respond to stimuli presented to the side contralateral to the site of lesion, despite the absence of significant sensory or motor deficits. The patient made reading and spelling errors only on the right half of words, regardless of length. Furthermore, she produced the same pattern of errors in reading and spelling, irrespective of the topographic arrangement of stimuli in reading (horizontal, vertical or mirror-reversed words) and of the type of response in spelling (written, oral or backward oral spelling). This pattern of performance suggests that order information in orthographic representations is coded spatially in a word-centred coordinate system; that is, in a spatially defined coordinate frame whose centre corresponds to the midpoint of a canonical, orientation-invariant representation of the word and not the midpoint of the word stimulus.
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29/46. Auditory perceptual problems in non-organic hearing disorder.

    A series of 22 patients who presented with non-organic hearing disorder were examined for auditory perceptual problems. A test battery that examined eight areas of auditory perception revealed significant auditory perceptual problems in each of the 22 patients. The results indicate a view that differs from the traditional view of non-organic hearing disorder as either conscious feigning of a hearing disorder or an unconscious symptom of an unidentified emotional disorder. The information presented here indicates that specific auditory processing disorders could adversely affect patients' hearing and that auditory perceptual disorders could be diagnosed and treated.
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30/46. Distinguishing auditory and speech-specific perceptual deficits.

    The ability to discriminate speech and nonspeech auditory stimuli was tested in a learning disabled child. The perception of speech stimuli was normal when the stimuli were presented in quiet but below normal when the stimuli were presented in noise. Although the perception of pure tone stimuli and environmental sounds was normal both in quiet and noise, the perception of nonspeech stimuli with rapid changes in acoustic information was impaired in noise. These findings illustrate the importance of relating performance for speech and complex nonspeech stimuli in investigating the basis of speech perceptual deficits. Whereas abnormal performance for speech stimuli coupled with normal performance for complex nonspeech stimuli argues for the existence of specialized speech processing mechanisms, abnormal performance for both types of stimuli, as was found in the present subject, argues for the existence of more generalized auditory processing mechanisms.
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