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Imaging Correlates

Gilbert Wunderlich, MD; Boris Suchan, PhD; Jens Volkmann, MD; Hans Herzog, PhD; Volker Hömberg, MD; Rüdiger J. Seitz, MD

Arch Neurol. 2000;57:561-565.

Objective  To investigate the cerebral metabolic and functional patterns during recovery from cortical blindness.

Design  Follow-up study with serial clinical, metabolic, and functional imaging and visual evoked potentials.

Case Presentation  A 24-year-old woman suffered from cortical blindness after cardiac arrest and recovered over a 6-month period. During recovery, she experienced complex visual hallucinations that could be initiated by visual imagery.

Results  Initially, the regional cerebral metabolic rate of glucose was severely reduced in the visual and parieto-occipital cortex bilaterally but recovered almost completely. Visual hallucinations led to significant increases of the regional cerebral blood flow in the initially severely hypometabolic parieto-occipital and temporolateral cortex.

Conclusions  Recovery of vision was related to normalization of the postlesionally dysfunctional cortex. Visual hallucinations appeared as the clinical correlate of the electrophysiological hyperexcitability of the recovering partially damaged visual cortex.

From the Neurologische Klinik, Heinrich-Heine-Universität (Drs Wunderlich, Volkmann, and Seitz), and the Neurologisches Therapiecentrum (Drs Suchan and Hömberg), Düsseldorf, and the Institut für Medizin, Forschungszentrum Jülich, Jülich (Drs Wunderlich and Herzog), Germany.

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