The double dissociation between cortical blindness and aphantasia: a review of 55 cases
PsyArXiv Preprints June 19, 2026 preprint DOI: osf:mqt76_v2 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review |
|---|---|
| Sample size | 55 |
| Population | Patients with cortical blindness |
| Keywords | Fusiform imagery node Neurological aphantasia Visual mental imagery Cognitive neuroscience Clinical neuroscience Behavioral neuroscience Perception Vision Cognitive psychology Consciousness |
| Key findings | Visual mental imagery persists after complete destruction of V1, indicating V1 is not necessary for imagery. |
Abstract
A long-standing assumption in cognitive neuroscience is that visual mental imagery (VMI) is “visual perception in reverse” and, as such, requires reactivation of the primary visual cortex (V1). On this view, total destruction of V1 should abolish VMI and provoke neurological aphantasia. We tested this prediction by reviewing 55 published cases of cortical blindness (CB) in which VMI abilities were assessed. Vivid VMI is repeatedly documented in CB patients with complete or near-complete bilateral destruction, disconnection, or functional loss of V1; in impaired-VMI cases with informative anatomical or functional evidence, the lesion extends well beyond V1, typically into the left temporal cortex. No impaired-VMI case with informative anatomical or functional evidence shows damage confined to V1. These data are incompatible with a necessary role for V1 in VMI and instead align with recent neuroimaging and lesion evidence pointing to a left temporal hub (the fusiform imagery node, FIN) together with domain-preferring ventral temporal regions, embedded within frontoparietal working memory and semantic networks. We outline practical guidelines for future neuropsychological studies of visual mental imagery in CB.