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H₂¹⁵O Positron Emission Tomographic Activation Study

Luigi Pizzamiglio, MD; Daniela Perani, MD; Stefano F. Cappa, MD; Giuseppe Vallar, MD; Stefano Paolucci, MD; Franco Grassi, MD; Eraldo Paulesu, MD; Ferruccio Fazio, MD

Arch Neurol. 1998;55:561-568.

Background  The neural correlates of recovery of unilateral neglect (ULN), as well as of other consequences of focal brain damage, are largely unknown. Functional neuroimaging methods (in particular, positron emission tomography [PET]) can be applied to the in vivo study of recovery mechanisms in neurologic patients.

Objective  To evaluate the functional cerebral correlates of recovery from ULN in patients with right-sided lesions, with the use of a PET activation paradigm.

Methods  Study of 3 patients with cerebrovascular lesions that involved corticosubcortical (patient 1) or subcortical (patients 2 and 3) areas of the right hemisphere. Unilateral neglect was tested twice, before and after completion of a 2-month rehabilitation program, after which all 3 patients showed considerable improvement. Similarly, 2 PET examinations were performed, before and after recovery, during the performance of a visuospatial task requiring the patients to detect and respond to visual targets moving on a computer screen from the right to the left visual hemifield (experimental condition). The cerebral activation was compared with a baseline task in which subjects responded to a black dot flashing in a fixed position of the right hemifield.

Results  The brain areas activated by the performance of the visuospatial task before and after recovery were compared. In all 3 patients, the regions notably more active after recovery were almost exclusively found in right-sided cortical areas and largely overlapped with those observed in a group of 4 normal subjects performing the same task. Other areas, which have been shown to be involved in attentional and oculomotor tasks in other PET studies, were also activated in patients with ULN.

Conclusions  The behavioral recovery of ULN in these patients with predominantly subcortical lesions is mainly associated with cerebral activations in cortical regions similar to those observed in normal subjects. There is some evidence of functional reorganization in individual subjects, which involves other areas related to space representation and exploration.

From the Faculty of Psychology, Universita' di Roma "La Sapienza" (Drs Pizzamiglio and Vallar), and the Center for Research of Neuropsychology–Istituto di Ricovero e Cura a Carattere Scientifico Clinica S. Lucia (Drs Pizzamiglio, Vallar, and Paolucci), Rome, Italy; INB-Consiglio Nazionale delle Ricereche, University of Milan, Scientific Institute H. S. Raffaele (Drs Perani, Grassi, Paulesu, and Fazio), Milan, Italy; and the Neurology Clinic, Universita' di Brescia, Brescia, Italy (Dr Cappa).

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