J. Cogn. Neurosci.
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(Journal of Cognitive Neuroscience. 2002;14:629-636.)
© 2002 The MIT Press

Visualizing the Neural Bases of a Disconnection Syndrome with Diffusion Tensor Imaging

N. Molko

Service INSERM, Hospitalier Frédéric Joliot

L. Cohen

Service INSERM, Hospitalier Frédéric Joliot
Hôpital de la Salpêtrière

J. F. Mangin

UNAF, Service Hospitalier Frédéric Joliot, Comisariat á l'Energie Atanique

F. Chochon and S. Lehéricy

Hôpital de la Salpêtrière

D. Le Bihan

UNAF, Service Hospitalier Frédéric Joliot, Comisariat á l'Energie Atanique

S. Dehaene

Service INSERM, Hospitalier Frédéric Joliot

Disconnection syndromes are often conceptualized exclusively within cognitive box-and-arrow diagrams unrelated to brain anatomy. In a patient with alexia in his left visual field resulting from a posterior callosal lesion, we illustrate how diffusion tensor imaging can reveal the anatomical bases of a disconnection syndrome by tracking the degeneration of neural pathways and relating it to impaired fMRI activations and behavior. Compared to controls, an abnormal pattern of brain activity was observed in the patient during word reading, with a lack of activation of the left visual word form area (VWFA) by left-hemifield words. Statistical analyses of diffusion images revealed a damaged fiber tract linking the left ventral occipito-temporal region to its right homolog across the lesioned area of corpus callosum and stopping close to the areas found active in fMRI. The behavioral disconnection syndrome could, thus, be related functionally to abnormal fMRI activations and anatomically to the absence of a connection between those activations. The present approach, based on the "negative tracking" of degenerated bundles, provides new perspectives on the understanding of human brain connections and disconnections.




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