Brain and Behavior. 2018;8:e01010.
1 of 10
Altered white matter connectivity associated with visual
hallucinations following occipital stroke
Sara A. Rafique
| John R. Richards
| Jennifer K. E. Steeves
provided the original work is properly cited.
©2018TheAuthors. Brain and BehaviorpublishedbyWileyPeriodicals,Inc.
Department of Emergency
Introduction: Visual hallucinations that arise following vision loss stem from aberrant
functional activity in visual cortices and an imbalance of activity across associated
cortical and subcortical networks subsequent to visual pathway damage. We sought
to determine if structural changes in white matter connectivity play a role in cases of
chronic visual hallucinations associated with visual cortical damage.
Methods: We performed diffusion tensor imaging (DTI) and probabilistic fiber trac-
tography to assess white matter connectivity in a patient suffering from continuous
and disruptive phosphene (simple) visual hallucinations for more than 2 years follow-
ing right occipital stroke. We compared these data to that of healthy age- matched
Results: Probabilistic tractography to reconstruct white matter tracts suggests re-
generation of terminal fibers of the ipsilesional optic radiations in the patient.
seeded from the ipsilesional visual cortex to the intrahemispheric lateral geniculate
ter tracts in the patient connecting the visual cortex with frontal and temporal
Conclusions: Cortical remapping and the disruption of communication between vis-
ual cortices and remote regions are consistent with our previous functional magnetic
resonance imaging (fMRI) data showing imbalanced functional activity of the same
regions in this patient (Rafique etal,2016,Neurology, 87,1493–1500). Long-term
adaptive and disruptive changes in white matter connectivity may account for the
rare nature of cases presenting with chronic and continuous visual hallucinations.