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The Visual System

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Clinical Neuroanatomy

Abstract

The topography of the visual pathways is of great importance in clinical neurology. Since the pathways extend from the orbit to the occipital pole, they are often involved in brain lesions as illustrated in several Clinical cases. The visual pathways are highly organized, and lesions in different parts of the visual system produce characteristic visual-field defects, which usually provide clues about the location of the underlying pathological process (Sects. 8.2 and 8.4). Up to the primary visual or striate cortex (V1), the visual pathway represents a serial relay with a clear retinotopic arrangement. Beyond the striate cortex, the projection to extrastriate visual cortex proliferates into a complex web of parallel projections, back-projections and interconnections among a large number of specialized cortical modules (Sect. 8.3). More than 40 of these modules have been identified in monkeys. Early recognized visual areas such as V2, V3 and V3A form a peristriate zone surrounding the primary visual cortex and receive direct input from V1. These regions respond differently to form, colour, depth and motion. Beyond this peristriate zone, a dichotomy of the extrastriate visual areas into a ventral (“what”) and a dorsal (“where”) system has been proposed (Sect. 8.5).

The ventral or temporal system may be specialized in object recognition and, in primates, consists of V4 and the various subregions of the infratemporal cortex and, in humans, of the ventral parts of areas 18 and 19 and the medial occipitotemporal cortex. Lesions of the medial occipitotemporal cortex, which is vascularized by the posterior cerebral artery (PCA), may cause dyschromatopsia and a variety of visual agnosias, including prosopagnosia and alexia. The dorsal or parietal system may be specialized in spatial aspects of vision and consists of V5 (middle temporal area or MT), V5a (medial superior temporal area or MST) and regions of the posterior parietal cortex. Many of these areas selectively respond to motion, stereodisparity and spatial attention. The dorsal stream lies largely in the watershed area between the cerebral arteries. Lesions of the cuneus and posterior parietal lobe cause visuospatial disorders, such as impaired motion perception, spatial disorientation and defects in attention. Many vascular lesions do not correspond to the anatomical dichotomy, however, and show a mixture of dorsal and ventral impairment.

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  1. 935 Department of Neurology, Radboud University Nijmegen Medical Centre, 9101, 6500 HB, Nijmegen, The Netherlands

    Hans J. ten Donkelaar

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ten Donkelaar, H.J. (2011). The Visual System. In: Clinical Neuroanatomy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-19134-3_8

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