Reduction in posterior cerebral artery blood flow velocity during caloric vestibular stimulation

Cortical Integration of Vestibular and Visual Cues for Navigation, Visual Processing, and Perception

Despite increasing evidence of its involvement in several key functions of the cerebral cortex, the vestibular sense rarely enters our consciousness. Indeed, the extent to which these internal signals are incorporated within cortical sensory representation and how they might be relied upon for sensory-driven decision-making, during, for example, spatial navigation, is yet to be understood. Recent novel experimental approaches in rodents have probed both the physiological and behavioral significance of vestibular signals and indicate that their widespread integration with vision improves both the cortical representation and perceptual accuracy of self-motion and orientation. Here, we summarize these recent findings with a focus on cortical circuits involved in visual perception and spatial navigation and highlight the major remaining knowledge gaps. We suggest that vestibulo-visual integration reflects a process of constant updating regarding the status of self-motion, and access to such information by the cortex is used for sensory perception and predictions that may be implemented for rapid, navigation-related decision-making.

Time-varying caloric vestibular stimulation for the treatment of neurodegenerative disease

Time-varying caloric vestibular stimulation (tvCVS) is a new form of non-invasive neuromodulation similar to, but different from, diagnostic caloric vestibular stimulation (CVS). Using a non-invasive, solid-state delivery device, tvCVS has been successfully used in a human clinical trial with Parkinson’s disease (PD) subjects. Additionally, the effects of tvCVS on brain activation have been studied in healthy human subjects using transcranial Doppler sonography (TCD) and functional magnetic resonance imaging (BOLD fMRI). A novel finding in the TCD and fMRI studies was the induction of cerebral blood flow velocity (CBFv) oscillations. How such oscillations might lead to the observed clinical effects seen in PD subjects will be discussed. Enabling studies of tvCVS with rodents is an attractive goal in support of explorations of the mechanism of action. Male Wistar rats were used in a proof-of-concept study described herein. Rats were anesthetized (isoflurane) and ventilated for the duration of the tvCVS runs. Time-varying thermal stimuli were administered using a digital temperature controller to modulate Peltier-type heater/cooler devices. Blunt ear bars conveyed the thermal stimulus to the external ear canals of the rats. Different thermal waveform combinations were evaluated for evidence of successful induction of the CVS effect. It was found that bilateral triangular thermal waveforms could induce oscillations in CBFv both during and after the application of tvCVS. These oscillations were similar to, but different from those observed in awake human subjects. The establishment of a viable animal model for the study of tvCVS will augment ongoing clinical investigations of this new form of neuromodulation in patients with neurodegenerative disease.

The Acute Effects of Time-Varying Caloric Vestibular Stimulation as Assessed With fMRI

We describe preliminary results from the application of time-varying caloric vestibular stimulation (tvCVS) to volunteers during a continuous blood oxygen level dependent (BOLD) functional MRI (fMRI) acquisition, recording baseline, during-tvCVS and post-tvCVS epochs. The modifications necessary to enable the use of this novel device in a 3-Tesla magnetic field are discussed. Independent component analysis (ICA) was used as a model-free method to highlight spatially and temporally coherent brain networks. The ICA results are consistent with tvCVS induction being mediated principally by thermoconvection in the vestibular labyrinth and not by direct thermal effects. The activation of hub networks identified by ICA is consistent with the concept of sensory neuromodulation, which posits that a modulatory signal introduced to a sensory organ is able to traverse the regions innervated (directly and indirectly) by that organ, while being transformed so as to be “matched” to regional neuronal dynamics. The data suggest that regional neurovascular coupling and a systemic cerebral blood flow component account for the BOLD contrast observed. The ability to modulate cerebral hemodynamics is of significant interest. The implications of these initial findings for the use of tvCVS therapeutically are discussed.

Non-Invasive Neuromodulation Using Time-Varying Caloric Vestibular Stimulation

Caloric vestibular stimulation (CVS) to elicit the vestibulo-ocular reflex has long been used in clinical settings to aid in the diagnosis of balance disorders and to confirm the absence of brainstem function. While a number of studies have hinted at the potential therapeutic applications of CVS, the limitations of existing devices have frustrated that potential. Current CVS irrigators use water or air during short-duration applications; however, this approach is not tenable for longer duration therapeutic protocols or home use. Here, we describe a solid-state CVS device we developed in order to address these limitations. This device delivers tightly controlled time-varying thermal waveforms, which can be programmed through an external control unit. It contains several safety features, which limit patients to the prescribed waveform and prevent the potential for temperature extremes. In this paper, we provide evidence that CVS treatment with time-varying, but not constant temperature waveforms, elicits changes in cerebral blood flow physiology consistent with the neuromodulation of brainstem centers, and we present results from a small pilot study, which demonstrate that the CVS can safely and feasibly be used longitudinally in the home setting to treat episodic migraine. Together, these results indicate that this solid-state CVS device may be a viable tool for non-invasive neuromodulation.

Vertigo and the processing of vestibular information: A review in the context of predictive coding

This article investigates the processing of vestibular information by interpreting current experimental knowledge in the framework of predictive coding. We demonstrate that this theoretical framework give us insights into several important questions regarding specific properties of the vestibular system. Particularly, we discuss why the vestibular network is more spatially distributed than other sensory networks, why a mismatch in the vestibular system is more clinically disturbing than in other sensory systems, why the vestibular system is only marginally affected by most cerebral lesions, and whether there is a primary vestibular cortex. The use of predictive coding as a theoretical framework further points to some problems with the current interpretation of results that are gained from vestibular stimulation studies. In particular, we argue that cortical responses of vestibular stimuli cannot be interpreted in the same way as responses of other sensory modalities. Finally, we discuss the implications of the new insights, hypotheses and problems that were identified in this review on further directions of research of vestibular information processing.

Case Report of Vestibularly evoked Visual Hallucinations in a Patient with Cortical Blindness

Previous work has shown that caloric vestibular stimulation may evoke elementary visual hallucinations in healthy humans, such as different colored lines or dots. Surprisingly, the present case report reveals that the same stimulation can evoke visual hallucinations in a patient with cortical blindness, but with fundamentally different characteristics. The visual hallucinations evoked were complex and came from daily life experiences. Moreover, they did not include other senses beyond vision. This case report suggests that in conditions of cerebral pathology, vestibular-visual interaction may stimulate hallucinogenic subcortical, or undamaged cortical structures, and arouse mechanisms that can generate visual images exclusively.

Feasibility of transcranial Doppler and single photon emission computed tomography in compound neuroactivation task

The aim of this study was to test feasibility of transcranial Doppler (TCD) and single photon emission computed tomography (SPECT) during compound neuroactivation task. The study was performed in 60 healthy right-handed volunteers. Cerebral blood flow velocity was measured by TCD in both middle cerebral arteries (MCA) at baseline and during computer game. The same stimulus and response pattern was used in 15 subjects that additionally underwent brain SPECT. Percentage differences between measurements were determined through quantitative result assessment. Both methods detected a statistically significant cerebral blood flow increase during neuroactivation. Correlation of TCD and SPECT showed statistically significant correlation only for the increase of cerebral blood flow velocity in the right MCA and for the right-sided cerebral blood flow increase, demonstrating that both methods partially measure similar cerebral blood flow changes that occur during neuroactivation. Comparison of TCD and SPECT showed TCD to be inadequately sensitive method for evaluation of cerebral blood flow during complex activation paradigm.

The thalamocortical vestibular system in animals and humans

The vestibular system provides the brain with sensory signals about three-dimensional head rotations and translations. These signals are important for postural and oculomotor control, as well as for spatial and bodily perception and cognition, and they are subtended by pathways running from the vestibular nuclei to the thalamus, cerebellum and the "vestibular cortex." The present review summarizes current knowledge on the anatomy of the thalamocortical vestibular system and discusses data from electrophysiology and neuroanatomy in animals by comparing them with data from neuroimagery and neurology in humans. Multiple thalamic nuclei are involved in vestibular processing, including the ventroposterior complex, the ventroanterior-ventrolateral complex, the intralaminar nuclei and the posterior nuclear group (medial and lateral geniculate nuclei, pulvinar). These nuclei contain multisensory neurons that process and relay vestibular, proprioceptive and visual signals to the vestibular cortex. In non-human primates, the parieto-insular vestibular cortex (PIVC) has been proposed as the core vestibular region. Yet, vestibular responses have also been recorded in the somatosensory cortex (area 2v, 3av), intraparietal sulcus, posterior parietal cortex (area 7), area MST, frontal cortex, cingulum and hippocampus. We analyze the location of the corresponding regions in humans, and especially the human PIVC, by reviewing neuroimaging and clinical work. The widespread vestibular projections to the multimodal human PIVC, somatosensory cortex, area MST, intraparietal sulcus and hippocampus explain the large influence of vestibular signals on self-motion perception, spatial navigation, internal models of gravity, one's body perception and bodily self-consciousness.

Vestibular effects on cerebral blood flow

Background

Humans demonstrate a number of unique adaptations that allow for the maintenance of blood pressure and brain blood flow when upright. While several physiological systems, including cerebral autoregulation, are involved in this adaptation the unique role the vestibular system plays in helping to maintain brain blood flow is just beginning to be elucidated. In this study, we tested the hypothesis that stimulation of the vestibular system, specifically the otoliths organs, would result in changes in cerebral blood flow.

Results

To test our hypothesis, we stimulated the vestibular organs of 25 healthy subjects by pitch tilt (stimulates both canals and otoliths) and by translation on a centrifuge (stimulates otoliths and not the canals) at five frequencies: 0.5, 0.25, 0.125 and 0.0625 Hz for 80 sec and 0.03125 Hz for 160 sec. Changes in cerebral flow velocity (by transcranial Doppler) and blood pressure (by Finapres) were similar during both stimuli and dependent on frequency of stimulation (P < 0.01). However, changes in cerebral blood flow were in opposition to changes in blood pressure and not fully dependent on changes in end tidal CO₂.

Conclusion

The experimental results support our hypothesis and provide evidence that activation of the vestibular apparatus, specifically the otolith organs, directly affects cerebral blood flow regulation, independent of blood pressure and end tidal CO₂ changes.

Vertigo and cerebral hemoglobin changes during unilateral caloric stimulation: a near-infrared spectroscopy study

The aim of the present study using near-infrared spectroscopy (NIRS) is to evaluate the correlation of cerebral (parieto-temporal lobe) hemoglobin changes and vertiginous sensation during unilateral caloric stimulation. During the hot water (44 degrees C) stimulus, cerebral hemoglobin was increased bilaterally, but it was dominant ipsilaterally. During the unilateral cold water (30 degrees C) stimulus, cerebral hemoglobin was decreased on both sides, especially on the ipsilateral side. Vertigious sensation was strong in cases with marked left-right difference of cerebral hemoglobin changes. The usefulness of NIRS to investigate the relationship between peripheral vestibular organ and vestibular cortex was verified.

The influence of caloric nystagmus on flash evoked transient and steady-state potentials

OBJECTIVE

Caloric stimulation leads to a reduction of the cerebral blood flow in the visual cortex. This reduction has been attributed to the suppression of visual input caused by nystagmus induced by caloric stimulation. We investigated the influence of caloric stimulation on transient flash and steady-state flash visual evoked potentials.

METHODS

Visual evoked potentials to 1 and 10 Hz flash stimulation were recorded in 12 normal subjects at baseline, during nystagmus induced by caloric stimulation with cold water, and after the cessation of nystagmus.

RESULTS

Neither the amplitude of the transient flash visual evoked potentials (1 Hz stimulation) nor the amplitude of the steady-state flash visual evoked potentials (10 Hz stimulation) was influenced by caloric stimulation compared to baseline.

CONCLUSIONS

The deactivation of the visual cortex by caloric stimulation does not seem to affect transient flash or steady-state flash visual evoked potentials. Reduction of cerebral blood flow in the visual cortex does not affect the processing of visual qualities (e.g., luminance and pattern).

SIGNIFICANCE

Caloric stimulation does not reduce the amplitudes of transient flash or steady-state flash visual evoked potentials.

Oscillopsies : approches physiopathologique et thérapeutique

Oscillopsia is an illusion of an unstable visual world. It is associated with poor visual acuity and is a disabling and stressful symptom reported by numerous patients with neurological disorders. The goal of this paper is to review the physiology of the systems subserving stable vision, the various pathophysiological mechanisms of oscillopsia and the different treatments available. Visual stability is conditioned by two factors. First, images of the seen world projected onto the retina have to be stable, a sine qua non condition for foveal discriminative function. Vestibulo-ocular and optokinetic reflexes act to stabilize the retinal images during head displacements; ocular fixation tends to limit the occurrence of micro ocular movements during gazing; a specific system also acts to maintain the eyes stable during eccentric gaze. Second, although we voluntary move our gaze (body, head and eye displacements), the visual world is normally perceived as stable, a phenomenon known as space constancy. Indeed, complex cognitive processes compensate for the two sensory consequences of gaze displacement, namely an oppositely-directed retinal drift and a change in the relationship between retinal and spatial (or subject-centered) coordinates of the visual scene. In patients, oscillopsia most often results from abnormal eye movements which cause excessive motion of images on the retina, such as nystagmus or saccadic intrusions or from an impaired vestibulo-ocular reflex. Understanding the exact mechanisms of impaired eye stability may lead to the different treatment options that have been documented in recent years. Oscillopsia could also result from an impairment of spatial constancy mechanisms that in normal condition compensate for gaze displacements, but clinical data in this case are scarce. However, we suggest that some visuo-perceptive deficits consecutive to temporo-parietal lesions resemble oscillopsia and could result from a deficit in elaborating spatial constancy.

Detection of cerebral oxyhaemoglobin changes during vestibular Coriolis cross-coupling stimulation using near infrared spectroscopy

Near infrared spectroscopy (NIRS) has been successful in monitoring cerebral haemodynamics when the subject is immobilized during surgery, and when there is a drastic depletion of blood from the cerebral cortex during positive acceleration. In this study, we monitored subtle changes of cerebral oxygen level using NIRS during vestibular stimulation. For the control conditions, cerebral oxygen status was monitored in six stationary subjects sitting upright, and while they executed head movements in the pitch axis with eyes opened and eyes closed. The experimental conditions involved the subjects making a head movement which required a 45 degrees pitch-down followed by a return to upright head movements 12 s later during yaw rotation (Coriolis cross coupling) at 10 and 20 rotations per minute (rpm) in a random order. Oxyhaemoglobin (O(2)Hb), deoxyhaemoglobin (HHb) and total haemoglobin levels were recorded every 0.5 s from both the parietal and the occipital lobe simultaneously. A significant rotation effect was observed in total Hb level changes from baseline in both regions. Occipital O(2)Hb increased significantly after the head movement with eyes opened at 20 rpm. Our findings appear to be consistent with previous vestibular studies that significant changes in brain blood flow occur during caloric stimulation. NIRS can be used to monitor discrete cortical blood flow changes resulting from vestibular and other forms of stimulation.

Visual mental imagery during caloric vestibular stimulation

We investigated high-resolution mental imagery and mental rotation, while the participants received caloric vestibular stimulation. High-resolution visual mental imagery tasks have been shown to activate early visual cortex, which is deactivated by vestibular input. Thus, we predicted that vestibular stimulation would disrupt high-resolution mental imagery; this prediction was confirmed. In addition, mental rotation tasks have been shown to activate posterior parietal cortex, which is also engaged in the processing of vestibular stimulation. As predicted, we also found that mental rotation is impaired during vestibular stimulation. In contrast, such stimulation did not affect performance of a low-imagery control task. These data document previously unsuspected interactions between the vestibular system and the high-level visual system.

Hemodynamics of the posterior cerebral arteries in neonates with periventricular leukomalacia

PURPOSE

The purpose of this study was to evaluate the cerebral blood flow of the posterior cerebral arteries (PCAs) in neonates in relation to the onset of periventricular leukomalacia (PVL).

METHODS

Among 57 low-birth-weight neonates studied, 7 were diagnosed with PVL with cyst formation on sonography and MRI. The mean cerebral blood flow velocity (CBFV) was measured in all the neonates by Doppler sonography through the posterior fontanel separately in the right and left PCA at days 0, 1, 2, 3, 4, 5, 7, 10, 14, 21, 28, 42, 56, and 70 following birth.

RESULTS

In the 7 neonates with PVL the mean CBFV in the right PCA was significantly lower than that in neonates without PVL at days 10, 14, 21, 28, 42, 56, and 70; the mean CBFV in the left PCA of neonates with PVL was significantly lower than that in those without PVL at days 7, 10, 14, 21, 28, 42, 56, and 70. CBFV measured in neonates without PVL exhibited a gradual increase postnatally. In contrast, CBFV values for neonates with PVL plateaued after day 5 or 7.

CONCLUSIONS

The serial measurement of PCA CBFV postnatally may prove useful as a predictor of the development of PVL.

Magneto-encephalographic measurement of neural activity during period of vertigo induced by cold caloric stimulation

The aim of this study was to investigate neural activity during period of vertiginous sensation, induced by caloric stimulation. After caloric vestibular stimulation (CVS) by cold water of five volunteers (n=5, age: 30+/-10), auditory evoked magnetic fields (AEFs) during the subsequent period of vertiginous sensations were measured by magnetoencephalography (MEG). Current-arrow maps (CAMs) were produced to estimate the spatial current distribution of the AEF responses, and a rotation value (dI(rot)) was calculated from the CAM. The worth of the dI(rot) values as indicators of vertigo was evaluated by comparing them with earlier reported values for elderly control (n=11, age: 67+/-5) and chronic dizziness (CD) (n=27, age: 68+/-8) groups (obtained from AEF responses with no the CVS). Although all volunteers felt vertigo during the AEF measurements, the AEF waveforms and CAM pattern only showed slight changes. While the dI(rot) values (1.43+/-0.73) just after CVS were not significantly different from those (1.59+/-0.46) for the elderly controls, they were significantly different from those (3.54+/-1.34) for the CD patients. These findings suggest that (i) the new parameter (dI(rot)) is more sensitively indicates dizziness (non-rotatory sensation) than vertigo (ii) the auditory cortical region may play an important role in body-balance perception of floating sensations.

Cortical and subcortical vestibular response to caloric stimulation detected by functional magnetic resonance imaging

The posterior insula, central sulcus, and inferior parietal lobule including the intraparietal sulcus have been considered the vestibular cortex based on functional brain mapping in humans as well as experiments in lower primates. The same regions receive optokinetic, visual, and proprioceptive projections. We examined the cortical and subcortical projection of vestibular activity with visual and proprioceptive input eliminated during caloric stimulation (CS), using functional magnetic resonance imaging (fMRI). Single-shot gradient-echo echoplanar image (EPI) volumes were sensitive to BOLD contrast in oblique orientation. We adopted a pharmacokinetic model for analysis of imaging data from 10 subjects as a group. The insular gyrus, intraparietal sulcus, superior temporal gyrus, hippocampus, cingulate gyrus, and thalamus showed activation by CS. Cortical and subcortical activation during CS in the present study was observed within regions less precisely delineated by other methods. As intraparietal sulcus activation showed right hemispheric dominance, this region may have an oculomotor projection as well as the vestibular input.

Velocity not acceleration of self-motion mediates vestibular-visual interaction

We investigated the influence of vestibular stimulation with different angular accelerations and velocities on the perception of visual motion direction. Constant accelerations resulting in different angular velocities and constant angular velocities obtained at different accelerations were combined in twenty healthy subjects. Random-dot kinematograms with coherently moving pixels and randomly moving pixels were used as visual stimuli during whole-body rotations. The smallest percentage of coherently moving pixels leading to a clear perception of motion direction was taken as the perception threshold. Perception thresholds significantly increased with increasing angular velocity. Increased acceleration, however, had no significant effect on the perception thresholds. We conclude that the achieved angular velocity, and not acceleration, is the predominant factor in the processing of vestibular-visual interaction.

Vestibular evoked blood flow response in the basilar artery

BACKGROUND AND PURPOSE

Monitoring of the basilar artery (BA) is difficult and has been sparsely performed. The aim of this study was to present physiological data of functional transcranial Doppler sonography (TCD) of the BA during caloric vestibular stimulation in healthy volunteers.

METHODS

TCD of the BA was performed in 26 healthy volunteers (14 women, 12 men, age 25.1+/-3 years) during caloric vestibular stimulation. Vertigo was documented using electronystagmography (ENG) and a subjective vertigo scale ranging from 0 to 10 points. Simultaneously, capnogpraphy was performed.

RESULTS

All subjects experienced vertigo, nausea and oszillopsia during vestibular irrigation. The average subjective vertigo was for a period of 106 s (+/-65.4); the average subjective estimated degree of vertigo was 6.7 points (+/-1.5). In all subjects, ENG demonstrated horizontal nystagm to the left non-irrigated side. In 14 subjects the subjective vertigo was rated by the individuals as extreme (point score > or =7) and in 12 subjects as low (point score <7). Mean flow velocity (MFV) in the BA increased significantly during vestibular irrigation, being more prominent in the initial irrigation and vertigo phase (5.8+/-5.9%, P<0.05) than in the second vertigo phase (2.2+/-8.8%, P<0.05). The calculated pulsatility index (PI), which indicates the condition of the small resistance vessels, decreased significantly (-4.9+/-8.1%; 4.3+/-8.9%, P<0.05) during both phases of vestibular activation. End tidal pCO2 did not change significantly (constant 5.4+/-0.4 Vol%), but respiration frequency was significantly increased during vestibular stimulation (12.3+/-3.8 min(-1) to 16.4+/-5.3 min(-1) and 16.3+/-4.8 min(-1), P<0.05) probably as a vegetative sign of vertigo. The observed MFV- and PI-changes were more prominent, although not quite significant, in the subgroup of subjects who experienced extreme subjective vertigo than in the subgroup who experienced low subjective vertigo.

CONCLUSION

These observations indicate that MFV increase in the posterior circulation is due to activation of the vestibulocerebellum. In addition, it is possible that the previously elaborated MFV increase in the MCA might contribute to MFV increase in the BA via the posterior communicating artery. The difference in the 2 subgroups (extreme vertigo vs. low vertigo) may reflect the great variety of anatomical and physiological conditions of the peripheral vestibular organ, the brainstem anatomy and the corresponding blood supply. For clinical purposes this TCD-test may contribute to the investigation of the vasomotor reserve of the posterior circulation, e.g. in patients with vertebrobasilar ischemia, bilateral vestibular loss or local neurodegenerative disease.

The vestibular cortex. Its locations, functions, and disorders

Evidence is presented that the multisensory parieto-insular cortex is the human homologue of the parieto-insular vestibular cortex (PIVC) in the monkey and is involved in the perception of verticality and self-motion. Acute lesions (patients with middle cerebral artery infarctions) of this area caused contraversive tilts of perceived vertical, body lateropulsion, and, rarely, rotational vertigo. Brain activation studies using positron emission tomography or functional magnetic resonance tomography showed that PIVC was activated by caloric irrigation of the ears or by galvanic stimulation of the mastoid. This indicates that PIVC receives input from both the semicircular canals and otoliths. PIVC was also activated during small-field optokinetic stimulation, but not when the nystagmus was suppressed by fixation. Activation of vestibular cortex areas, visual motion-sensitive areas, and ocular motor areas exhibited a significant right-hemispheric dominance. The vestibular cortex intimately interacts with the visual cortex to match the two 3-D orientation maps (perception of verticality, room-tilt illusion) and mediates self-motion perception by means of a reciprocal inhibitory visual-vestibular interaction. This mechanism of an inhibitory interaction allows a shift of the dominant sensorial weight during self-motion perception from one sensory modality (visual or vestibular) to the other, depending on which mode of stimulation prevails: body acceleration (vestibular input) or constant velocity motion (visual input).