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Most of us can use our "mind's eye" to mentally visualize things that are not in our direct line of sight, an ability known as visual mental imagery. Extensive left temporal damage can impair patients' visual mental imagery experience, but the critical locus of lesion is unknown. Our recent meta-analysis of 27 fMRI studies of visual mental imagery highlighted a well-delimited region in the left lateral midfusiform gyrus, which was consistently activated during visual mental imagery, and which we called the Fusiform Imagery Node (FIN). Here, we describe the connectional anatomy of FIN in neurotypical participants and in RDS, a right-handed patient with an extensive occipito-temporal stroke in the left hemisphere. The stroke provoked right homonymous hemianopia, alexia without agraphia, and color anomia. Despite these deficits, RDS had normal subjective experience of visual mental imagery and reasonably preserved behavioral performance on tests of visual mental imagery of object shape, object color, letters, faces, and spatial relationships. We found that the FIN was spared by the lesion. We then assessed the connectional anatomy of the FIN in the MNI space and in the patient's native space, by visualizing the fibers of the inferior longitudinal fasciculus (ILF) and of the arcuate fasciculus (AF) passing through the FIN. In both spaces, the ILF connected the FIN with the anterior temporal lobe, and the AF linked it with frontal regions. Our evidence is consistent with the hypothesis that the FIN is a node of a brain network dedicated to voluntary visual mental imagery. The FIN could act as a bridge between visual information and semantic knowledge processed in the anterior temporal lobe and in the language circuits. [ABSTRACT FROM AUTHOR]

• Models of visual mental imagery highlight the importance of early visual areas. • Temporal, not occipital lesions impair visual mental imagery in neurological patients. • We performed an ALE meta-analysis of fMRI studies of visual mental imagery. • Visual mental imagery engages fronto-parietal networks and the left fusiform gyrus. • Our results reconcile neuroimaging evidence with cognitive neurology. The dominant neural model of visual mental imagery (VMI) stipulates that memories from the medial temporal lobe acquire sensory features in early visual areas. However, neurological patients with damage restricted to the occipital cortex typically show perfectly vivid VMI, while more anterior damages extending into the temporal lobe, especially in the left hemisphere, often cause VMI impairments. Here we present two major results reconciling neuroimaging findings in neurotypical subjects with the performance of brain-damaged patients: (1) A large-scale meta-analysis of 46 fMRI studies, of which 27 investigated specifically visual mental imagery, revealed that VMI engages fronto-parietal networks and a well-delimited region in the left fusiform gyrus. (2) A Bayesian analysis showed no evidence for imagery-related activity in early visual cortices. We propose a revised neural model of VMI that draws inspiration from recent cytoarchitectonic and lesion studies, whereby fronto-parietal networks initiate, modulate, and maintain activity in a core temporal network centered on the fusiform imagery node, a high-level visual region in the left fusiform gyrus. [ABSTRACT FROM AUTHOR]