Time is vision: functional preservation and enhanced capacity for recovery in subacute occipital stroke

Abstract

Stroke damage to the primary visual cortex (V1) causes a loss of vision known as hemianopia or cortically-induced blindness (CB). While early, spontaneous, perimetric improvements can occur, by 6 months post-stroke, the deficit is considered chronic and permanent. Despite evidence from sensorimotor stroke showing that early injury responses heighten neuroplastic potential, to date, rehabilitation research has focused only on chronic CB patients. Consequently, little is known about the functional properties of subacute, post-stroke visual systems, and whether they can be harnessed to enhance visual recovery. Here, for the first time, we show that conscious visual discrimination abilities are partially preserved inside subacute, perimetrically-defined blind fields, disappearing by 6 months post-stroke. Complementing this discovery, we show that global motion discrimination training initiated subacutely leads to comparable magnitude of recovery as that initiated in chronic CB. However, it does so 6 times faster, generalizes to deeper, untrained regions of the blind field, and to other [untrained] aspects of motion perception, preventing their degradation upon reaching the chronic period. Untrained subacutes exhibited only spontaneous improvements in perimetry - spontaneous recovery of motion discriminations was never observed. Thus, in CB, the early post-stroke period appears characterized by gradual - rather than sudden - loss of visual processing. Subacute training stops this degradation, and is dramatically more efficient at eliciting recovery than identical training in the chronic period. Finally, spontaneous improvements in subacutes appear restricted to luminance detection, whereas recovering discrimination abilities requires deliberate training. Simply stated, after an occipital stroke, "time is VISION". One Sentence SummaryThe first 3 months after an occipital stroke are characterized by a gradual - not sudden - loss of visual perceptual abilities and increased rehabilitative potential if visual discrimination training is administered in the blind field.