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Graefes Arch Clin Exp Ophthalmol (2012) 250:14911497 DOI 10.1007/s00417-012-1958-z
NEURO-OPHTHALMOLOGY
Facial dysmorphopsia: a notable variant of the "thin man" phenomenon?
Martin Ganssauge & Eleni Papageorgiou &
Ulrich Schiefer
Received: 24 November 2011 /Revised: 22 January 2012 /Accepted: 30 January 2012 /Published online: 3 March 2012 # Springer-Verlag 2012
AbstractBackground The aim of this work is to investigate the facial distortion (dysmorphopsia) experienced by patients with homonymous paracentral scotomas and to analyze the interrelationship with the previously described thin man phenomenon.
Methods Routine neuro-ophthalmological examination and brain MRI in three patients who suffered from small homonymous paracentral scotomas due to infarction or arteriovenous malformations of the occipital lobe. They all complained of distortion and shrinkage of their interlocutors face contralateral to the brain lesion. The phenomenon appeared some seconds after steady fixation on the interlocutors nose and was evident with both left and right homonymous scotomas. The patients did not notice a gap in the area corresponding to the scotoma and objects other than faces were perceived normally.
Results Homonymous paracentral scotomas can lead to focal displacement of facial features towards the center of the field defect with resulting distortion of the face on the affected side. This so-called dysmorphopsia makes faces appear regionally narrower than they are in reality and may be induced even by visual field defects that
remain undetected by conventional perimetry using 6 6 grids. Predilection for faces is probably associated with the superior location of scotomas or specific impairment of face processing abilities related to the lesion site.
Conclusions Facial dysmorphopsia is most probably associated with cortical filling-in and spatial distortion, and can hence be regarded as a special entity of the thin man phenomenon.
Keywords Facial dysmorphopsia . Filling-in . Thin man phenomenon . Paracentral homonymous scotomas
Introduction
In contrast to former beliefs, neuronal maps in the adult brain do not seem to be fixed and neuronal remodeling can occur in areals surrounding a cortical lesion. This phenomenon is known as plasticity of the cortex, and refers to the brains ability to reorganize and compensate for the effects of injury and disease [1, 2]. Uninjured brain regions are thought to respond to the damage of other regions by taking over the lost functions. Remapping following lesions in the primary visual...