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Monica Narcisa Toba, Raffaella Migliaccio, Michel Thiebaut de Schotten, Pascale Pradat-Diehl, Catherine Loeper-Jeny, Paolo Bartolomeo; A combined structural MRI and tractography approach in visuospatial neglect. Journal of Vision 2011;11(11):187. doi: 10.1167/11.11.187.
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Patients with right hemisphere lesions and visual neglect fail to orient and respond to left-sided objects. There is general agreement that neglect is a heterogenous, multi-componential syndrome, but the location and identity of the relevant lesion sites remain debated. Twenty-five right-handed patients with subacute strokes in the right hemisphere performed a paper-and-pencil neglect battery. Their performance (scores on each individual neglect test) was mapped to cortical lesions by using voxel-based lesion-symptom mapping (VLSM) method. The principal white matter (WM) association bundles were reconstructed by using diffusion tensor imaging (DTI) tractography. DTI-derived metrics of WM integrity for each tract (fractional anisotropy, mean diffusivity, as well as radial and parallel diffusivities) were also obtained. Distinct cortical regions including the right angular and supramarginal gyri, as well as the middle frontal gyrus were specifically associated with deficits obtained on specific tests. VLSM and tractography both revealed that damage to the right anterior segment of the arcuate fasciculus, connecting Broca's territory with the inferior parietal lobe, correlated with pathological scores in all the tests used. These results indicate an essential role of the WM damage in neglect and open the way for an interpretation of performance dissociations in neglect on the basis of WM bundles disconnections.
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