Insular and occipital changes in visual snow syndrome: a BOLD fMRI and MRS study.

Puledda, Francesca; Ffytche, Dominic; Lythgoe, David J; O'Daly, Owen; Schankin, Christoph; Williams, Steven C R; Goadsby, Peter J (2020). Insular and occipital changes in visual snow syndrome: a BOLD fMRI and MRS study. Annals of Clinical and Translational Neurology, 7(3), pp. 296-306. Wiley 10.1002/acn3.50986

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OBJECTIVE To investigate the pathophysiology of visual snow (VS), through a combined functional neuroimaging and magnetic resonance spectroscopy (1 H-MRS) approach. METHODS We applied a functional MRI block-design protocol studying the responses to a visual stimulation mimicking VS, in combination with 1 H-MRS over the right lingual gyrus, in 24 patients with VS compared to an equal number of age- and gender-matched healthy controls. RESULTS We found reduced BOLD responses to the visual stimulus with respect to baseline in VS patients compared to controls, in the left (k = 291; P = 0.025; peak MNI coordinate [-34 12 -6]) and right (k = 100; P = 0.003; peak MNI coordinate [44 14 -2]) anterior insula. Our spectroscopy analysis revealed a significant increase in lactate concentrations in patients with respect to controls (0.66 ± 0.9 mmol/L vs. 0.07 ± 0.2 mmol/L; P < 0.001) in the right lingual gyrus. In this area, there was a significant negative correlation between lactate concentrations and BOLD responses to visual stimulation (P = 0.004; r = -0.42), which was dependent on belonging to the patient group. INTERPRETATION As shown by our BOLD analysis, VS is characterized by a difference in bilateral insular responses to a visual stimulus mimicking VS itself, which could be due to disruptions within the salience network. Our results also suggest that patients with VS have a localized disturbance in extrastriate anaerobic metabolism, which may in turn cause a decreased metabolic reserve for the regular processing of visual stimuli.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Schankin, Christoph Josef


600 Technology > 610 Medicine & health








Chantal Kottler

Date Deposited:

14 Jul 2020 16:44

Last Modified:

24 Jul 2020 21:07

Publisher DOI:


PubMed ID:





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