Response to visual threat following damage to the pulvinar.

We present a unique case demonstrating contributions of the pulvinar in response to visual threat. Substantial evidence demonstrates that the amygdala contributes to the emotion of fear and the response to threat. Traditionally, two routes to amygdala activation have been distinguished: a "slow cortical" route through visual and association cortex and a "fast subcortical" route through the thalamus. The pulvinar nucleus of the thalamus is well connected to the amygdala, suggesting that pulvinar damage might interfere with amygdala activation and response to threat. We tested this possibility in patient SM, who suffered complete loss of the left pulvinar. We measured interference from threatening images on goal-directed behavior. In SM's ipsilesional field, threatening images slowed responses more than pleasant images did. This interference decreased rapidly over time. In contrast, in SM's contralesional field, interference from threatening images was initially absent and then increased rather than decreased over time. Processing through the pulvinar therefore plays a significant role in generating response to visual threat. We suggest that, with disruption of the subcortical route to the amygdala, briefly presented images were not fully processed for threat. The reemergence of interference over time may reflect contributions of a slower route.