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Lapenna R, Faralli M, Del Zompo MR, Cipriani L, Mobaraki PD, Ricci G. Reliability of an anamnestic questionnaire for the diagnosis of benign paroxysmal positional vertigo in the elderly. Aging Clin Exp Res 2016; 28:881-8. [PMID: 26537236 DOI: 10.1007/s40520-015-0487-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is common agreement in the literature that it can result in an underestimation of benign paroxysmal positional vertigo (BPPV) in the elderly. AIMS The aim of this work was to analyze the role of anamnesis in the diagnosis of BPPV in patients of different ages through the development and validation of a scored questionnaire. METHODS The questionnaire is based on the presence/absence of six typical anamnestic features of BPPV. The Mini-Mental State Exam (MMS) was also administered to patients over 65 years of age. Bedsides, examination for BPPV was then carried out, assigning the outcome of the questionnaire and eventual MMS to the final diagnosis for each patient. RESULTS The sensitivity and specificity of the questionnaire for high scores (>8) were found to be, respectively, 86 % and 80 % in all patients, 94 and 71 % in those under 65 years of age, 78 and 90 % in patients over 65, and, in particular, 63 and 83 % in those with MMS >24 and 100 and 100 % in those with MMS ≤24. DISCUSSION The reliability and average score of the questionnaire were statistically significantly lower in the group of elderly patients without cognitive deficits. The lower reliability of the questionnaire in the geriatric population, rather than the presence of cognitive deterioration, seems to correlate with other comorbidities or simply to a lower mobility of the head triggering positional symptoms. CONCLUSION The use of the questionnaire could however reduce the risk of a missed diagnosis of BPPV given its good reliability across all ages.
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Alberts BB, de Brouwer AJ, Selen LP, Medendorp WP. A Bayesian Account of Visual-Vestibular Interactions in the Rod-and-Frame Task. eNeuro 2016; 3:ENEURO.0093-16.2016. [PMID: 27844055 PMCID: PMC5093328 DOI: 10.1523/eneuro.0093-16.2016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/19/2016] [Accepted: 09/26/2016] [Indexed: 12/19/2022] Open
Abstract
Panoramic visual cues, as generated by the objects in the environment, provide the brain with important information about gravity direction. To derive an optimal, i.e., Bayesian, estimate of gravity direction, the brain must combine panoramic information with gravity information detected by the vestibular system. Here, we examined the individual sensory contributions to this estimate psychometrically. We asked human subjects to judge the orientation (clockwise or counterclockwise relative to gravity) of a briefly flashed luminous rod, presented within an oriented square frame (rod-in-frame). Vestibular contributions were manipulated by tilting the subject's head, whereas visual contributions were manipulated by changing the viewing distance of the rod and frame. Results show a cyclical modulation of the frame-induced bias in perceived verticality across a 90° range of frame orientations. The magnitude of this bias decreased significantly with larger viewing distance, as if visual reliability was reduced. Biases increased significantly when the head was tilted, as if vestibular reliability was reduced. A Bayesian optimal integration model, with distinct vertical and horizontal panoramic weights, a gain factor to allow for visual reliability changes, and ocular counterroll in response to head tilt, provided a good fit to the data. We conclude that subjects flexibly weigh visual panoramic and vestibular information based on their orientation-dependent reliability, resulting in the observed verticality biases and the associated response variabilities.
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Affiliation(s)
- Bart B.G.T. Alberts
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Anouk J. de Brouwer
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
- Centre for Neuroscience Studies, Queen’s University Kingston, Kingston, Canada
| | - Luc P.J. Selen
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - W. Pieter Medendorp
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, Nijmegen, The Netherlands
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Price CJ, Hope TM, Seghier ML. Ten problems and solutions when predicting individual outcome from lesion site after stroke. Neuroimage 2016; 145:200-208. [PMID: 27502048 DOI: 10.1016/j.neuroimage.2016.08.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 07/08/2016] [Accepted: 08/04/2016] [Indexed: 12/17/2022] Open
Abstract
In this paper, we consider solutions to ten of the challenges faced when trying to predict an individual's functional outcome after stroke on the basis of lesion site. A primary goal is to find lesion-outcome associations that are consistently observed in large populations of stroke patients because consistent associations maximise confidence in future individualised predictions. To understand and control multiple sources of inter-patient variability, we need to systematically investigate each contributing factor and how each factor depends on other factors. This requires very large cohorts of patients, who differ from one another in typical and measurable ways, including lesion site, lesion size, functional outcome and time post stroke (weeks to decades). These multivariate investigations are complex, particularly when the contributions of different variables interact with one another. Machine learning algorithms can help to identify the most influential variables and indicate dependencies between different factors. Multivariate lesion analyses are needed to understand how the effect of damage to one brain region depends on damage or preservation in other brain regions. Such data-led investigations can reveal predictive relationships between lesion site and outcome. However, to understand and improve the predictions we need explanatory models of the neural networks and degenerate pathways that support functions of interest. This will entail integrating the results of lesion analyses with those from functional imaging (fMRI, MEG), transcranial magnetic stimulation (TMS) and diffusor tensor imaging (DTI) studies of healthy participants and patients.
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Affiliation(s)
- Cathy J Price
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, UCL, UK.
| | - Thomas M Hope
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, UCL, UK
| | - Mohamed L Seghier
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, UCL, UK; Educational Neuroscience Research Centre, ECAE, Abu Dhabi, United Arab Emirates
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54
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Subjective body vertical: a promising diagnostic tool in idiopathic normal pressure hydrocephalus? J Neurol 2016; 263:1819-27. [DOI: 10.1007/s00415-016-8186-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 05/02/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022]
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Brosel S, Laub C, Averdam A, Bender A, Elstner M. Molecular aging of the mammalian vestibular system. Ageing Res Rev 2016; 26:72-80. [PMID: 26739358 DOI: 10.1016/j.arr.2015.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 12/16/2015] [Accepted: 12/21/2015] [Indexed: 12/18/2022]
Abstract
Dizziness and imbalance frequently affect the elderly and contribute to falls and frailty. In many geriatric patients, clinical testing uncovers a dysfunction of the vestibular system, but no specific etiology can be identified. Neuropathological studies have demonstrated age-related degeneration of peripheral and central vestibular neurons, but the molecular mechanisms are poorly understood. In contrast, recent studies into age-related hearing loss strongly implicate mitochondrial dysfunction, oxidative stress and apoptotic cell death of cochlear hair cells. While some data suggest that analogous biological pathomechanisms may underlie vestibular dysfunction, actual proof is missing. In this review, we summarize the available data on the molecular causes of vestibular dysfunction.
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Affiliation(s)
- Sonja Brosel
- German Center for Vertigo and Balance Disorders, Department of Neurology, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany.
| | - Christoph Laub
- Department of Neurology with Friedrich-Baur-Institute, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Anne Averdam
- Department of Neurology with Friedrich-Baur-Institute, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany
| | - Andreas Bender
- Department of Neurology, Therapiezentrum Burgau, Kapuzinerstr.34, 89331 Burgau, Germany
| | - Matthias Elstner
- Department of Neurology with Friedrich-Baur-Institute, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany; Department of Neurology and Clinical Neurophysiology, Academic Hospital Munich-Bogenhausen, Technical University of Munich, Englschalkingerstr. 77, 81925 Munich, Germany
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56
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Göttlich M, Jandl NM, Sprenger A, Wojak JF, Münte TF, Krämer UM, Helmchen C. Hippocampal gray matter volume in bilateral vestibular failure. Hum Brain Mapp 2016; 37:1998-2006. [PMID: 26918638 DOI: 10.1002/hbm.23152] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 02/11/2016] [Indexed: 01/26/2023] Open
Abstract
Bilateral vestibular failure (BVF) is a severe chronic disorder of the labyrinth or the eighth cranial nerve characterized by unsteadiness of gait and disabling oscillopsia during head movements. According to animal data, vestibular input to the hippocampus is proposed to contribute to spatial memory and spatial navigation. Except for one seminal study showing the association of impaired spatial navigation and hippocampal atrophy, patient data in BVF are lacking. Therefore, we performed a voxel-wise comparison of the hippocampal gray matter volume (GMV) in a clinically representative sample of 27 patients with incomplete BVF and 29 age- and gender-matched healthy controls to test the hypothesis of hippocampal atrophy in BVF. Although the two groups did not generally differ in their hippocampal GMV, a reduction of GMV in the bilateral hippocampal CA3 region was significantly correlated with increased vestibulopathy-related clinical impairment. We propose that GMV reduction in the hippocampus of BVF patients is related to the severity of vestibular-induced disability which is in line with combined hippocampal atrophy and disorders of spatial navigation in complete vestibular deafferentation due to bilateral nerve section. Clinically, however, the most frequent etiologies of BVF cause incomplete lesions. Accordingly, hippocampus atrophy and deficits in spatial navigation occur possibly less frequently than previously suspected. Hum Brain Mapp 37:1998-2006, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Martin Göttlich
- Department of Neurology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Nico M Jandl
- Department of Neurology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Andreas Sprenger
- Department of Neurology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany.,Institute of Psychology II, University of Lübeck, Lübeck, Germany
| | - Jann F Wojak
- Department of Neurology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany.,Institute of Psychology II, University of Lübeck, Lübeck, Germany
| | - Ulrike M Krämer
- Department of Neurology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany.,Institute of Psychology II, University of Lübeck, Lübeck, Germany
| | - Christoph Helmchen
- Department of Neurology, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany
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Besnard S, Lopez C, Brandt T, Denise P, Smith PF. Editorial: The Vestibular System in Cognitive and Memory Processes in Mammalians. Front Integr Neurosci 2015; 9:55. [PMID: 26617498 PMCID: PMC4639622 DOI: 10.3389/fnint.2015.00055] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/19/2015] [Indexed: 12/16/2022] Open
Affiliation(s)
- Stéphane Besnard
- COMETE, Institut National de la Santé et de la Recherche Médicale U1075, Normandy University Caen, France
| | - Christophe Lopez
- Centre National de la Recherche Scientifique, NIA UMR 7260, Aix Marseille Université Marseille, France
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders Munich, Germany
| | - Pierre Denise
- COMETE, Institut National de la Santé et de la Recherche Médicale U1075, Normandy University Caen, France
| | - Paul F Smith
- Department of Pharmacology and Toxicology and the Brain Health Research Centre, University of Otago Medical School Dunedin, New Zealand
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Pfeiffer C, van Elk M, Bernasconi F, Blanke O. Distinct vestibular effects on early and late somatosensory cortical processing in humans. Neuroimage 2015; 125:208-219. [PMID: 26466979 DOI: 10.1016/j.neuroimage.2015.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/31/2015] [Accepted: 10/01/2015] [Indexed: 11/28/2022] Open
Abstract
In non-human primates several brain areas contain neurons that respond to both vestibular and somatosensory stimulation. In humans, vestibular stimulation activates several somatosensory brain regions and improves tactile perception. However, less is known about the spatio-temporal dynamics of such vestibular-somatosensory interactions in the human brain. To address this issue, we recorded high-density electroencephalography during left median nerve electrical stimulation to obtain Somatosensory Evoked Potentials (SEPs). We analyzed SEPs during vestibular activation following sudden decelerations from constant-velocity (90°/s and 60°/s) earth-vertical axis yaw rotations and SEPs during a non-vestibular control period. SEP analysis revealed two distinct temporal effects of vestibular activation: An early effect (28-32ms post-stimulus) characterized by vestibular suppression of SEP response strength that depended on rotation velocity and a later effect (97-112ms post-stimulus) characterized by vestibular modulation of SEP topographical pattern that was rotation velocity-independent. Source estimation localized these vestibular effects, during both time periods, to activation differences in a distributed cortical network including the right postcentral gyrus, right insula, left precuneus, and bilateral secondary somatosensory cortex. These results suggest that vestibular-somatosensory interactions in humans depend on processing in specific time periods in somatosensory and vestibular cortical regions.
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Affiliation(s)
- Christian Pfeiffer
- Laboratoire de Recherche en Neuroimagerie (LREN), Department of Clinical Neuroscience, Lausanne University and University Hospital, Lausanne, Switzerland; Center for Neuroprosthetics, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland; Laboratory of Cognitive Neuroscience, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - Michiel van Elk
- Department of Psychology, University of Amsterdam, Netherlands
| | - Fosco Bernasconi
- Center for Neuroprosthetics, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland; Laboratory of Cognitive Neuroscience, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland
| | - Olaf Blanke
- Center for Neuroprosthetics, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland; Laboratory of Cognitive Neuroscience, Brain Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland; Department of Neurology, University Hospital Geneva, Switzerland.
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59
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Conrad J, Habs M, Brandt T, Dieterich M. Acute Unilateral Vestibular Failure Does Not Cause Spatial Hemineglect. PLoS One 2015; 10:e0135147. [PMID: 26247469 PMCID: PMC4527734 DOI: 10.1371/journal.pone.0135147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/17/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Visuo-spatial neglect and vestibular disorders have common clinical findings and involve the same cortical areas. We questioned (1) whether visuo-spatial hemineglect is not only a disorder of spatial attention but may also reflect a disorder of higher cortical vestibular function and (2) whether a vestibular tone imbalance due to an acute peripheral dysfunction can also cause symptoms of neglect or extinction. Therefore, patients with an acute unilateral peripheral vestibular failure (VF) were tested for symptoms of hemineglect. METHODS Twenty-eight patients with acute VF were assessed for signs of vestibular deficits and spatial neglect using clinical measures and various common standardized paper-pencil tests. Neglect severity was evaluated further with the Center of Cancellation method. Pathological neglect test scores were correlated with the degree of vestibular dysfunction determined by the subjective visual vertical and caloric testing. RESULTS Three patients showed isolated pathological scores in one or the other neglect test, either ipsilesionally or contralesionally to the VF. None of the patients fulfilled the diagnostic criteria of spatial hemineglect or extinction. CONCLUSIONS A vestibular tone imbalance due to unilateral failure of the vestibular endorgan does not cause spatial hemineglect, but evidence indicates it causes mild attentional deficits in both visual hemifields.
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Affiliation(s)
- Julian Conrad
- Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders—IFB (DSGZ), Munich, Germany
- * E-mail:
| | - Maximilian Habs
- Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders—IFB (DSGZ), Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders—IFB (DSGZ), Munich, Germany
- Clinical Neuroscience, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, Ludwig-Maximilians-University Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders—IFB (DSGZ), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Ludwig-Maximilians-University Munich, Munich, Germany
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60
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Dieterich M, Brandt T. The bilateral central vestibular system: its pathways, functions, and disorders. Ann N Y Acad Sci 2015; 1343:10-26. [DOI: 10.1111/nyas.12585] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marianne Dieterich
- Department of Neurology; Ludwig-Maximilians-University Munich; München Germany
- German Center for Vertigo and Balance Disorders-IFB; Ludwig-Maximilians-University Munich; München Germany
- Munich Cluster for Systems Neurology (SyNergy); Munich Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders-IFB; Ludwig-Maximilians-University Munich; München Germany
- Clinical Neuroscience, Ludwig-Maximilians-University Munich; München Germany
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Brandt T, Dieterich M. Does the vestibular system determine the lateralization of brain functions? J Neurol 2014; 262:214-5. [PMID: 25346066 DOI: 10.1007/s00415-014-7548-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/16/2014] [Indexed: 11/26/2022]
Affiliation(s)
- T Brandt
- Institute for Clinical Neurosciences and German Center for Vertigo and Balance Disorders-IFB, Ludwig-Maximilians University Munich, Marchioninistr. 15, 81377, Munich, Germany,
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