左中部梭状回枕颞沟内皮质对汉字加工的必要性、选择性和作用性质

A number of functional neuroimaging studies with skilled readers consistently showed activation to visual words in the left mid-fusiform cortex in occipitotemporal sulcus (LMFC-OTS). Neuropsychological studies also showed that lesions at left ventral occipitotemporal areas result in impairment in visual word processing. Based on these empirical observations and some theoretical speculations, a few researchers postulated that the LMFC-OTS is responsible for instant parallel and holistic extraction of the abstract representation of letter strings, and labeled this piece of cortex as “visual word form area” (VWFA). Nonetheless, functional neuroimaging studies alone is basically a correlative rather than causal approach, and lesions in the previous studies were typically not constrained within LMFC-OTS but also involving other brain regions beyond this area. Given these limitations, it remains unanswered for three fundamental questions: is LMFC-OTS necessary for visual word processing? is this functionally selective for visual word processing while unnecessary for processing of non-visual word stimuli? what are its function properties in visual word processing? This thesis aimed to address these questions through a series of neuropsychological, anatomical and functional MRI experiments in four patients with different degrees of impairments in the left fusiform gyrus. Necessity: Detailed analysis of anatomical brain images revealed that the four patients had differential foci of brain infarction. Specifically, the LMFC-OTS was damaged in one patient, while it remained intact in the other three. Neuropsychological experiments showed that the patient with lesions in the LMFC-OTS had severe impairments in reading aloud and recognizing Chinese characters, i.e., pure alexia. The patient with intact LMFC-OTS but information from the left visual field (LVF) was blocked due to lesions in the splenium of corpus callosum, showed impairment in Chinese characters recognition when the stimuli were presented in the LVF but not in the RVF, i.e. left hemialexia. In contrast, the other two patients with intact LMFC-OTS had normal function in processing Chinese characters. The fMRI experiments demonstrated that there was no significant activation to Chinese characters in the LMFC-OTS of the pure alexic patient and of the patient with left hemialexia when the stimuli were presented in the LVF. On the other hand, this patient, when Chinese characters were presented in right visual field, and the other two with intact LMFC-OTS had activation in the LMFC-OTS. These results together point to the necessity of the LMFC-OTS for Chinese character processing. Selectivity: We tested selectivity of the LMFC-OTS for visual word processing through systematically examining the patients’ ability for processing visual vs. auditory words, and word vs. non-word visual stimuli, such as faces, objects and colors. Results showed that the pure alexic patients could normally process auditory words (expression, understanding and repetition of orally presented words) and non-word visual stimuli (faces, objects, colors and numbers). Although the patient showed some impairments in naming faces, objects and colors, his performance scores were only slightly lower or not significantly different relative to those of the patients with intact LMFC-OTS. These data provide compelling evidence that the LMFC-OTS is not requisite for processing non-visual word stimuli, thus has selectivity for visual word processing. Functional properties: With tasks involving multiple levels and aspects of word processing, including Chinese character reading, phonological judgment, semantic judgment, identity judgment of abstract visual word representation, lexical decision, perceptual judgment of visual word appearance, and dictation, copying, voluntary writing, etc., we attempted to reveal the most critical dysfunction caused by damage in the LMFC-OTS, thus to clarify the most essential function of this region. Results showed that in addition to dysfunctions in Chinese character reading, phonological and semantic judgment, the patient with lesions at LMFC-OTS failed to judge correctly whether two characters (including compound and simple characters) with different surface features (e.g., different fonts, printed vs. handwritten vs. calligraphy styles, simplified characters vs. traditional characters, different orientations of strokes or whole characters) had the same abstract representation. The patient initially showed severe impairments in processing both simple characters and compound characters. He could only copy a compound character in a stroke-by-stroke manner, but not by character-by-character or even by radical-by-radical manners. During the recovery process, namely five months later, the patient could complete the abstract representation tasks of simple characters, but showed no improvement for compound characters. However, he then could copy compound characters in a radical-by-radical manner. Furthermore, it seems that the recovery of copying paralleled to that of judgment of abstract representation. These observations indicate that lesions of the LMFC-OTS in the pure alexic patients caused several damage in the ability of extracting the abstract representation from lower level units to higher level units, and the patient had especial difficulty to extract the abstract representation of whole character from its secondary units (e.g., radicals or single characters) and this ability was resistant to recover from impairment. Therefore, the LMFC-OTS appears to be responsible for the multilevel (particularly higher levels) abstract representations of visual word form. Successful extraction seems independent on access to phonological and semantic information, given the alexic patient showed severe impairments in reading aloud and semantic processing on simple characters while maintenance of intact judgment on their abstract representation. However, it is also possible that the interaction between the abstract representation and its related information e.g. phonological and semantic information was damaged as well in this patient. Taken together, we conclude that: 1) the LMFC-OTS is necessary for Chinese character processing, 2) it is selective for Chinese character processing, and 3) its critical function is to extract multiple levels of abstract representation of visual word and possibly to transmit it to phonological and semantic systems.