Neural correlates of hysterical blindness

The neural mechanisms underlying conversion disorders such as hysterical blindness are at present unknown. Typically, patients are diagnosed through exclusion of neurological disease and the absence of pathologic neurophysiological diagnostic findings. Here, we investigate the neural basis of this disorder by combining electrophysiological (event-related potentials) and hemodynamic measures (functional magnet resonance tomography) in a patient with hysterical blindness before and after successful treatment. Importantly, the blindness was limited to the left upper and right lower visual quadrant offering the possibility to use the other 2 sighted quadrants as controls. While the functional magnetic resonance imaging activations were normal for visual stimulation electrophysiological indices of visual processing were modulated in a specific manner. Before treatment, the amplitude of the N1 event-related potentials component had smaller amplitudes for stimuli presented in the blind quadrants of the visual field. Following successful treatment the N1 component elicited by stimuli presented in formerly blind quadrants had a normal distribution without any amplitude differences between the 4 quadrants. The current findings point out that dissociative disorders such as hysterical blindness may have neurophysiological correlates. Furthermore, the observed neurophysiological pattern suggests an involvement of attentional mechanisms in the neural basis hysterical blindness.