国际眼科纵览

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高级视觉中枢损伤的诊断及治疗探索

刘婧雯  王佳伟   

  1. 100730 首都医科大学附属北京同仁医院神经内科
  • 收稿日期:2018-05-04 出版日期:2018-08-22 发布日期:2018-08-28
  • 通讯作者: 王佳伟,Email: wangjwcq@163.com E-mail:wangjwcq@163.com
  • 基金资助:

    国家自然科学基金(81771313);国家重点研发计划资助(2016YFC0904502);首都医科大学附属北京同仁医院“重点医学发展计划”专项(trzdyxzy201704)

Diagnosis and treatment of advanced visual center injury

LIU Jing-wen, WANG Jia-wei   

  1. Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
  • Received:2018-05-04 Online:2018-08-22 Published:2018-08-28
  • Contact: WANG Jia-wei, Email: wangjwcq@163.com E-mail:wangjwcq@163.com
  • Supported by:

    National Nature Sciense Fundation of China (81771313); National Key R & D Program of China (2016YFC0904502); Key Medical Development Plan of Beijing Tongren Hospital Affiliated to Capital Medical University(trzdyxzy201704)

摘要: 神经系统具有较强的可塑性,当主要的视觉处理区域V1受损时,经过胼胝体、丘脑枕投射至顶叶、颞叶等区域的替代视觉通路,会帮助患者恢复部分视觉功能。视觉中枢的腹侧通路的特定区域可专门识别面部、物体或者视觉场景,背侧通路选择性负责视觉空间定位。双侧枕叶损伤可出现完全视觉丧失(皮质盲),但患者不能意识到自己的缺陷。腹侧通路受损而背侧通路保留的患者可出现感知性视觉失认,即在视觉的基本方面(视力、视野等)均完整的情况下仍然不能识别视觉信息。中枢性偏侧色盲是当枕叶下部受损时对侧偏侧色觉减退或消失。角回及枕外侧回受损导致失读不伴失写,表现为不理解文字,不能通过视-文字途径阅读,但可以通过听觉、动觉、触觉等其他感觉途径来达到理解文字的目的。初级视皮层(V1)损伤可导致“盲视”,只有当物体移动时患者才能感知到,但是颜色和形状不能被识别。双侧顶叶损伤导致视觉注意机制破坏,患者不能将注意力转移到视觉场景的各个部分。面部识别核心网络受损导致人面识别功能障碍,患者甚至不认识自己的脸,但可通过其他特点对个体进行辨认。视皮质、中脑受损还可导致幻觉。“仿生眼”的深入研究和不断改进,使盲人重见光明成为可能。

Abstract:

Nervous system has strong plasticity, when the main visual processing area V1 damaged, projection through the corpus callosum and pulvinar to the parietal lobe and temporal lobe areas which are alternative visual pathways, will help patients recover part of the visual function. The specific areas of the ventral pathway of the visual center can be identified for the face, object or visual scene, and the dorsal pathway is selective for visual spatial positioning. Bilateral occipital lobe injury may present complete visual loss (cortical blindness), but patients are unable to recognize their defects. A person whose ventral pathway was impaired but had intact dorsal pathway perceived visual agnosia, refers to the basic aspects of vision (visual acuity, etc.) are complete but still does not recognize the visual information. Central hemiachromatopsia arises when a lesion in inferior occipital cortex diminishes or abolishes color vision in the contralateral hemifield. Impairment of angular gyrus and occipital lateral gyrus results in alexia without agraphia, as do not understand the words, not through the visual way of reading text, but can through auditory, kinesthetic, tactile and other sensory pathways to achieve the purpose of understanding the text. V1 damage can lead to "blindness". Only when the object moves, can the patient perceive it, but the color and shape can not be identified. Bilateral parietal lobe damage leads to the destruction of visual attention mechanism, patients are profoundly affected by an inability to disengage and shift their attention to various parts of a visual scene. Facial recognition core network damage causes human face recognition dysfunction, patients do not even recognize their faces, but can identify individuals through other characteristics. Visual cortex and midbrain damage can also lead to hallucinations. Further study and continuous improvement of bionic eye make it reality for blind to see light again.