Occipital Lobe

Anatomy and Function

with clinical correlation

By Dr Srimant Pattnaik, DM PDT

Neuromedicine , BIN
 Lesions in the occipital lobe
• Lesion of the primary visual area
• Lesion of the dorsal stream
• Lesion of ventral stream
 Lesions of primary visual cortex
1. Field defects
2. Cortical blindness
3. Anton ‘ s syndrome
FIELD DEFECTS
• Binocular field defect usually localizes to or
beyond optic chiasm
• Retrochiasmal lesions are usually
homonymous hemianopia
• Bilatreal optic nerve or retinal disease can
produce bilateral field defect
• Retinal disease has ophthalmoscoic finding
• Optic nerve problem has acuity problem
left lower bank of calcarine sulcus

Left upper bank of calcarine sucus

 case
• A patient recovering
from a right
hemipareisis, presented
to hospital with right
sided visual disturbance
Half moon or temporal crescent syndrome
 Cortical blindness
• Conceptualized as bilateral homonymous hemianopia.
Clinically blind.
• Due to blockage of bilateral PCA or distal Basilar artery
• Bilateral Area 17 involvement
• Central vision may be present (macular sparing): reason
for optokinetic nystagmus
• Pupilary reflex present
• Menace reflex ±
• VEP : no cortical potential
• EEG : loss of alpha rythm
• Visual imagination and visual imagery preserved
• Less complete bilateral lesion leave the patient with
varying degrees of visual perception
• There may be visual hallucination of either complex or
elementary type
• Recovery occurs in a regular fashion from cortical
blindness through visual agnosia and partially impaired
perceptual function to recovery
• After recovery , there may be p[roblems of visual
fatigue,fusion or fixation (3F’s)
 Anton syndrome
• Visual Anosognosia : self unawareness of
visual deficit. Denies blindness
• Iinvolvement of primary visual area along with
visual association area
• Behaves as if he can see
• Confabulates. Has excuses for blindness
 Inverse Anton Syndrome
• Also known as Blindism or Blindsight
• As such patient can not see but eye movements are
noticed in response to stimulus such as flashes of light
• Due to nonconscious visual processing
• Pathways
– Retino tectal
– Retino tecto pulvino extrastriate
– Geniculoextrastriate
• Simulates hysterical blindness
 Riddoch syndrome
• Cortical blindness but area V5 is spared
• Otherwise blind Patient can percieve moving
objects
• Hypothesis is of a direct connection between
LGB or Pulvinus to V5
 Lesions of ventral stream
1. Visual object agnosia
2. Colour vision abnormality
3. Prosopagnosia
4. Pure Alexia
 VISUAL OBJECT RECOGNITION
VISUAL STIMULI

VISUAL ANALYSIS

PRIMARY SKETCH

VIEWER CENTERED REPRESENATION

OBJECT CENTERED REPRESENTATION

SEMANTIC CONCEPTUAL FIELD PHONOLOGICAL LEXICON

PRIMARY SKETCH-2D MARR’S MODEL OF VISUAL
OBJECT RECOGNITION

VIEWER CENTERED SKETCH-2.5D

OBJECT CENTERED SKETCH-3D

SEMANTIC-CONCEPTUAL SYSTEM
 Visual Object Agnosia
• Apperceptive Visual agnosia
– Perceptual categorization defect
• Associative visual agnosia
 Apperceptive visual agnosia
VISUAL STIMULI

VISUAL ANALYSIS

PRIMARY SKETCH

VIEWER CENTERED REPRESENATION

OBJECT CENTERED REPRESENTATION

SEMANTIC CONCEPTUAL FIELD PHONOLOGICAL LEXICON

 Apperceptive visual agnosia
• Localization :
• bilateral lesion of calcarine cortex
• Occipitotemopral regions
• Pathology: mostly ischemic

• Most commonly seen during recovery from

cortical blindness
 Clinical feature
• Pick out details of the object in fragments i.e
lines adges, intensity but fail to identify the
whole picture
• They can not name objects presented to them
or draw them or match them
• Mostly act as blind but avoid obstacles while
walking
 Besdside tests
• Match test
• Figure copying test
Match test
Figure copying test
Perceptual categorization defect
VISUAL STIMULI

VISUAL ANALYSIS

PRIMARY SKETCH

VIEWER CENTERED REPRESENATION

OBJECT CENTERED REPRESENTATION

SEMANTIC CONCEPTUAL FIELD PHONOLOGICAL LEXICON

Perceptual categorization defect:contd
Perceptual categorization defect: contd

• Localization: right parietal lobe

• Patient can appreciate objects , match them
and and recognize them later as long as they
are presented in same conventional
orientation
 tests
VOSP
Incomplete letter test
Silhouettes
BORB
Gollin figures
Unusual view test
Foreshortened match
silhouettes
Unusual view test
Gollin figures
Foreshortened match
 Associative visual agnosia
VISUAL STIMULI

VISUAL ANALYSIS

PRIMARY SKETCH

VIEWER CENTERED REPRESENATION

OBJECT CENTERED REPRESENTATION

SEMANTIC CONCEPTUAL FIELD PHONOLOGICAL LEXICON

PRIMARY SKETCH-2D MARR’S MODEL OF VISUAL
OBJECT RECOGNITION

VIEWER CENTERED SKETCH-2.5D

OBJECT CENTERED SKETCH-3D

SEMANTIC-CONCEPTUAL SYSTEM
• Perception is stripped of meaning
• Patient can copy , match figures still can not say
what it is
• Can identify if object is presented by any other
modality
• Localized to bilateral posterior hemisphere
involving fusiform ot occipitotemporal gyri,
sometimes lingual gyrus and adjacent white
matter
 Tests
• Questionnaire
• Sorting of stimuli
• Matching visually dissimilar objects according
to similar function
• Real and unreal objects
• Pyramids and palm trees test
 Optic aphasia
VISUAL STIMULI

VISUAL ANALYSIS

PRIMARY SKETCH

VIEWER CENTERED REPRESENATION

OBJECT CENTERED REPRESENTATION

SEMANTIC CONCEPTUAL FIELD PHONOLOGICAL LEXICON

• Optic aphasia or optic anomia, an intermediate
between agnosia and aphasia
• Localization: left occipitotemporal area
• Can not name object presented visually but can
recognise when given cue
• Preserved recpognition of the objects
differentiates frm associative agnosia
• Recognition with auditory or tactile cue
differentiates it from anomic aphasia
Face recognition
 test
• Face identification from photographs
• Benton facial recognition test
 Prosopagnosia
• Difficulty in recognising familiar faces
• Recognise faces from a singular feature like
glasses , beards etc or non visual cues like voice
or social context
• Apperceptive vs associative
• Localization
– B/L damage to fusiform & lingual gyri
– U/L Rt OP lesion
– B/L or U/L anterior temporal lesion
 Causes of Prosopagnosia
• Congenital
– Hereditary : autosomal dominant inheritance
– Autistic spectrum disorder
• Acquired
– Stroke
– Herpes encephalitis
– Alzheimer
– Carbon monoxide poisoining
 COLOUR STIMULI

ACHROMATOPSIA

COLOUR
DISCRIMINATION

COLOUR AGNOSIA

COLOUR
CATEGORISATION

COLOUR
AMNESIA U R
O LO IA
C OM
SEMANTIC CONCEPTUAL AN COLOR NAMING
FIELD
 Cerebral Achromatopsia
• Localization : bilateral or nondominant inferior
occipito temporal lesions that damage lingual
and fusiform gyri sparing of calcarine cortex
 COLOUR AGNOSIA
• Colour is stripped off its meaning
• Can see and discriminate though
• Can not point or paint
• Inferomedial aspect of dominant occipital anfd
temporal lobe
 Colour Amnesia
• Defect in colour object association
• Can see, discriminate and point
• Can not paint
• Dominant hemisphere lesions
 Colour Anomia
• Basically the optic aphasia for colours
• Defective naming only
 ACHROMATOPSIA COLOUR COLOUR COLOR
AGNOSIA AMNESIA ANOMIA

ISHIHARA
CHART

COLOUR
PLATE
NAMING

POINTING TO
COLOUR

MATCHING
COLOUR

CONCEPTUAL
COLOUR
NAMING

COLOUR
PAINTING
 simultanagnosia
• Inability to comprehend a complex visual
scene despite being able to comprehend
individual items
• Divided into
• Ventral
• Dorsal
 SIMULTANAGNOSIA
DORSAL VENTRAL
LOCALIZATION B/L OCCIPITOPARIETAL LEFT OCCIPITOTEMPORAL
PATHOPHYSIOLOGY RESTRICTED VISUAL SLOW VISUAL PROCESSING
ATTENTION
CLINICALLY BLIND NOT SO
LEVEL OF PERCEPTION LIMITED TO ONE OBJECT SEVERAL OBJECTS
PERCIEVED, ONE
RECOGNIZED
SCATTERED DOT NOT ABLE TO DO ABLE TO DO
COUNTING
WORD READING CAN NOT READ WORDS READS BUT LETTER BY
LETTER
 Tests of ventral Simultanagnosia
Mixed figure testing Cookie theft picture
 Disorders of Dorsal stream
1. Balint Syndrome
2. Visual disorientation
3. Akinetopsia
4. Astereopsis
5. Visual extinction
 Balint syndrome
• Occurs due to lesion in
• Components
– Dorsal simultanagnosia
– Oculomotor apraxia
– Optic ataxia
 Dorsal Simultanagnosia
• Due to restriction of visual attention
• Perception is limited to point of fixation
without the awareness of presence of other
parts
• Miss forest for trees.
• Functionally blind as they find it difficult to
move about
 Oculomotor apraxia
• Not a true apraxia as the higher level motor
control is intact
• Also known as psychic paralysis of gaze
• Defective vision for action
• Deficit is a difficulty in shifting visual attention
to appropriate target
Optic ataxia
Optic ataxia
• Inability to reach a target under visual
guidance
• Defective action for vision
• No difficulty in touching body parts

• Tested by asking the patient to touch

examiner’s ear followed by touching own ear
 Visual disorientation
• Error in judging the location and distance of an
object, and in judging the relative distance
between the two objects
• Bump into things while walking
• Difficulty in finding door handle
• Problem arises when things are placed at
different level
• Difficulty in reaching things becomes difficult,
mimics optic ataxia
• However, visual disorientation improves with
repeated attempts, differentiating from optic
ataxia
 Astereopsis
• Loss of depth perception
• Depth is computed from binocular visual
information
• Retinal disparity is processed by the dorsal
stream
• Area 18 is primarily concerned with stereopsis
• Abnormality is seen due to bilateral damage,
more to the right side
astereopsis
akinetopsia
• Aquired defect of motion perception
• Sees moving people here and there
• Difficulty in pouring water from a cup to bottlr
as the water appears as ice
Visual extinction
 Visual hallucination
• Positive visual phenomena in absence of external stimuli
• Simple formed hallucination
• Light dots, bars, lines , stars, fog, coloured senasation
• Mostly after occpital stroke: good recovery
• Multicoloured wth spherical or circular pattern seen in
Occipital epileptic seizure
• Degenerative : AD,DLB
• Infective: CJD-Heidenhain variant
• Unformed hemifield hallucination post exercise : occiptal
lobe tumor
 Peduncular Hallucinosis
• Charcot – Willebrand syndrome
• Vivid,colourful,formed hallucination of
p[eople and animal
• Usually hypnogogic
• Pseudohallucinosis as patient knows they are
unreal
• Also seen in midbrain lesion as a release
hallucination
 Charles Bonnet Syndrome
• Seen in patients with visual loss due to
ophthalmological condition
• Well defined, organized and vivid scenes of
animals, flowers and people
• Also a pseudohallucination
• Can be abolished by repeated closing and
opening of eyes
• Deafferentiation of visual assdociation areas
leading to a form of phantom vision