Ischemic lesions to inferior frontal cortex alter the dynamics of conscious visual perception

Whether the prefrontal cortex is part of the neural correlates of conscious visual perception has been subject to longstanding debate. Recent work, using functional magnetic resonance imaging (fMRI) and repetitive transcranial magnetic stimulation (rTMS) to induce virtual lesions, has illustrated a key role of the right inferior frontal cortex (IFC) in the detection and resolution of perceptual ambiguities. Here, we sought to validate an active role of the IFC in conscious perception by evaluating how loss-of-function in patients with ischemic stroke in this region influences processing of ambiguous visual information. To this end, twenty-three patients (11 female, mean age 70.65 {+/-} 1.2 years) with chronic (>6 months), right-hemispheric ischemic stroke lesions within the MCA-territory (9 patients with IFC lesions, 14 without) performed a bistable perception task, having to report the perceived direction of rotation of an ambiguous random-dot-kinematogram (RDK). As hypothesized, patients with IFC lesions showed significantly fewer perceptual changes compared to patients without IFC lesions (IFC 44.9 {+/-} 46.3 s, non-IFC 28.2 {+/-} 37.1 s, T(182.9) =3.1, p = 2.2 x 10-3). Importantly, this effect remained significant when controlling for age, sex, stroke severity and lesion volume (T(5.97) = -2.9, p =0.026). Our results support the notion that the IFC is crucial for resolving perceptual ambiguities, suggesting an active role of frontal cortex in shaping conscious visual experience.