Higher Cortical Visual Disorders

Sashank Prasad, MD; Marc Dinkin, MD Neuro-ophthalmology p. 1329-1361 October 2019, Vol.25, No.5 doi: 10.1212/CON.0000000000000774
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PURPOSE OF REVIEW: This article reviews the disorders that result from disruption of extrastriate regions of the cerebral cortex responsible for higher visual processing. For each disorder, a historical perspective is offered and relevant neuroscientific studies are reviewed.

RECENT FINDINGS: Careful analysis of the consequences of lesions that disrupt visual functions such as facial recognition and written language processing has improved understanding of the role of key regions in these networks. In addition, modern imaging techniques have built upon prior lesion studies to further elucidate the functions of these cortical areas. For example, functional MRI (fMRI) has identified and characterized the response properties of ventral regions that contribute to object recognition and dorsal regions that subserve motion perception and visuospatial attention. Newer network-based functional imaging studies have shed light on the mechanisms behind various causes of spontaneous visual hallucinations.

SUMMARY: Understanding the regions and neural networks responsible for higher-order visual function helps the practicing neurologist to diagnose and manage associated disorders of visual processing and to identify and treat responsible underlying disease.

Address correspondence to Dr Sashank Prasad, Department of Neurology, Brigham and Women’s Hospital, 60 Fenwood Ave, Boston, MA 02115, sprasad2@bwh.harvard.edu.

RELATIONSHIP DISCLOSURE: Dr Prasad serves as an associate editor for the Journal of Neuro-Ophthalmology, receives publishing royalties from McGraw-Hill, and has provided expert medicolegal opinion on legal cases involving idiopathic intracranial hypertension, ischemic optic neuropathy, and traumatic brain injury. Dr Dinkin serves as an associate editor for the Journal of Neuro-Ophthalmology and as an editor for Practical Neurology and has received compensation for travel for speaking engagements from The American Austrian Foundation and research/grant support from the Helen and Robert Apel Foundation. Dr Dinkin has provided depositions and expert testimony on medicolegal cases involving idiopathic intracranial hypertension, ischemic optic neuropathy, and head trauma.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Prasad and Dinkin report no disclosures.

© 2019 American Academy of Neurology.