Abnormal Connectivity and Brain Structure in Patients With Visual Snow

Njoud Aldusary; Ghislaine L Traber; Patrick Freund; Fabienne C Fierz; Konrad P Weber; Arwa Baeshen; Jamaan Alghamdi; Bujar Saliju; Shila Pazahr; Reza Mazloum; Fahad Alshehri; Klara Landau; Spyros Kollias; Marco Piccirelli; Lars Michels

doi:10.3389/fnhum.2020.582031

Abnormal Connectivity and Brain Structure in Patients With Visual Snow

Front Hum Neurosci. 2020 Nov 19:14:582031. doi: 10.3389/fnhum.2020.582031. eCollection 2020.

Authors

Njoud Aldusary^{1

2}, Ghislaine L Traber^{3

4

5}, Patrick Freund^{6

7

8}, Fabienne C Fierz³, Konrad P Weber^{3

8}, Arwa Baeshen^{1

9}, Jamaan Alghamdi², Bujar Saliju³, Shila Pazahr¹, Reza Mazloum^{1

10}, Fahad Alshehri^{1

11}, Klara Landau³, Spyros Kollias¹, Marco Piccirelli¹, Lars Michels¹

Affiliations

¹ Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland.
² Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
³ Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁴ Department of Ophthalmology, University of Basel, Basel, Switzerland.
⁵ Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland.
⁶ Spinal Cord Injury Center Balgrist, University of Zurich, Zurich, Switzerland.
⁷ Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
⁸ Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁹ Department of Radiological Sciences, Faculty of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
¹⁰ Institute of Robotics and Intelligent Systems, D-HEST, ETH Zurich, Zurich, Switzerland.
¹¹ Radiology, College of Medicine, Qassim University, Al Qassim, Saudi Arabia.

Abstract

Objective: Visual snow (VS) is a distressing, life-impacting condition with persistent visual phenomena. VS patients show cerebral hypermetabolism within the visual cortex, resulting in altered neuronal excitability. We hypothesized to see disease-dependent alterations in functional connectivity and gray matter volume (GMV) in regions associated with visual perception.

Methods: Nineteen patients with VS and 16 sex- and age-matched controls were recruited. Functional magnetic resonance imaging (fMRI) was applied to examine resting-state functional connectivity (rsFC). Volume changes were assessed by means of voxel-based morphometry (VBM). Finally, we assessed associations between MRI indices and clinical parameters.

Results: Patients with VS showed hyperconnectivity between extrastriate visual and inferior temporal brain regions and also between prefrontal and parietal (angular cortex) brain regions (p < 0.05, corrected for age and migraine occurrence). In addition, patients showed increased GMV in the right lingual gyrus (p < 0.05 corrected). Symptom duration positively correlated with GMV in both lingual gyri (p < 0.01 corrected).

Conclusion: This study found VS to be associated with both functional and structural changes in the early and higher visual cortex, as well as the temporal cortex. These brain regions are involved in visual processing, memory, spatial attention, and cognitive control. We conclude that VS is not just confined to the visual system and that both functional and structural changes arise in VS patients, be it as an epiphenomenon or a direct contributor to the pathomechanism of VS. These in vivo neuroimaging biomarkers may hold potential as objective outcome measures of this so far purely subjective condition.

Keywords: functional connectivity; lingual gyrus; temporal cortex; visual snow; visual system.