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Nikles F, Kerkeni H, Zamaro E, Korda A, Wagner F, Sauter TC, Kalla R, Morrison M, Mantokoudis G. Do monosymptomatic stroke patients with dizziness present a vestibular syndrome without nystagmus? An underestimated entity. Eur J Neurol 2024; 31:e16066. [PMID: 37738525 DOI: 10.1111/ene.16066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND PURPOSE Vestibular symptoms are common in emergency department (ED) patients and have various causes, including stroke. Accurate identification of stroke in patients with vestibular symptoms is crucial for timely management. We conducted a prospective cross-sectional study from 2015 to 2019 to determine stroke prevalence and associated symptoms in ED patients with vestibular symptoms, aiming to improve diagnosis and outcomes. METHODS As part of the DETECT project, we screened 1647 ED patients with acute vestibular symptoms. Following a retrospective analysis of 961 head and neck magnetic resonance imaging (MRI) scans, we included 122 confirmed stroke cases and assessed them for vestibular signs and symptoms. RESULTS Stroke prevalence in dizzy patients was 13% (122/961 MRI scans). Most patients (95%) presented with acute vestibular symptoms with or without nystagmus, whereas 5% had episodic vestibular syndrome (EVS). Nystagmus was present in 50% of stroke patients. Eighty percent had a purely posterior circulation stroke, and nystagmus was absent in 46% of these patients. Seven patients (6%) had lesions in both the anterior and posterior circulation. Vertigo was experienced by 52% regardless of territory. CONCLUSIONS A stroke was identified in 13% of ED patients presenting with acute vestibular symptoms. In 5%, it was EVS. Most strokes were in the posterior circulation territory; vertigo occurred with similar frequency in anterior and posterior circulation stroke, and absence of nystagmus was common in both.
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Affiliation(s)
- Florence Nikles
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Hassen Kerkeni
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Ewa Zamaro
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Thomas C Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Roger Kalla
- Department of Neurology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
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Awosika OO, Garver A, Drury C, Sucharew HJ, Boyne P, Schwab SM, Wasik E, Earnest M, Dunning K, Bhattacharya A, Khatri P, Kissela BM. Insufficiencies in sensory systems reweighting is associated with walking impairment severity in chronic stroke: an observational cohort study. Front Neurol 2023; 14:1244657. [PMID: 38020645 PMCID: PMC10656616 DOI: 10.3389/fneur.2023.1244657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Walking and balance impairment are common sequelae of stroke and significantly impact functional independence, morbidity, and mortality. Adequate postural stability is needed for walking, which requires sufficient integration of sensory information between the visual, somatosensory, and vestibular centers. "Sensory reweighting" describes the normal physiologic response needed to maintain postural stability in the absence of sufficient visual or somatosensory information and is believed to play a critical role in preserving postural stability after stroke. However, the extent to which sensory reweighting successfully maintains postural stability in the chronic stages of stroke and its potential impact on walking function remains understudied. Methods In this cross-sectional study, fifty-eight community-dwelling ambulatory chronic stroke survivors underwent baseline postural stability testing during quiet stance using the modified Clinical test of Sensory Interaction in Balance (mCTSIB) and assessment of spatiotemporal gait parameters. Results Seventy-six percent (45/58) of participants showed sufficient sensory reweighting with visual and somatosensory deprivation for maintaining postural stability, albeit with greater postural sway velocity indices than normative data. In contrast, survivors with insufficient reweighting demonstrated markedly slower overground walking speeds, greater spatiotemporal asymmetry, and limited acceleration potential. Conclusion Adequate sensory system reweighting is essential for chronic stroke survivors' postural stability and walking independence. Greater emphasis should be placed on rehabilitation strategies incorporating multisensory system integration testing and strengthening as part of walking rehabilitation protocols. Given its potential impact on outcomes, walking rehabilitation trials may benefit from incorporating formal postural stability testing in design and group stratification.
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Affiliation(s)
- Oluwole O. Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Amanda Garver
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Colin Drury
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Heidi J. Sucharew
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Sarah M. Schwab
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Emily Wasik
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Melinda Earnest
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Amit Bhattacharya
- EDDI Lab—Early Detection of Degenerative Disorders and Innovative Solutions, Department of Environmental Health, University of Cincinnati, Cincinnati, OH, United States
| | - Pooja Khatri
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Brett M. Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
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Yeo SS, Nam SM, Cho IH. Injury of the Vestibulocerebellar Tract and Signs of Ataxia in Patients with Cerebellar Stroke. J Clin Med 2023; 12:6877. [PMID: 37959342 PMCID: PMC10649050 DOI: 10.3390/jcm12216877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The vestibulocerebellar tract (VCT) is responsible for maintaining balance, spatial orientation, and coordination. Damage to the vestibular system is accompanied by symptoms of balance disorder or ataxia. This study aimed to compare cerebellar dysfunction according to VCT damage in patients with cerebellar stroke. METHODS Six patients with cerebellum injury were recruited. This study measured ataxia and hand function related to visuomotor integration and manual dexterity using the Purdue pegboard test. The primary and bilateral secondary VCTs were reconstructed to investigate the integrity of pathways using diffusion tensor imaging (DTI). RESULTS The ataxia sign was positive in five patients (83%) at onset. In the result of the pegboard test, all patients had hand dysfunction in the dominant hand (100%). Likewise, all patients also had non-dominant hand dysfunction (100%). On the DTI tractography, the left and right primary VCTs of the patients demonstrated a 25% injury rate. Furthermore, the injury rates of ipsilateral and contralateral secondary VCTs were 50% and 58%. CONCLUSIONS Ataxia is related to secondary VCTs, and hand dysfunction is also related to VCTs. Therefore, we believe that the current study will be helpful in evaluating and providing a clinical intervention strategy for patients with ataxia and hand dysfunction following cerebellar injury.
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Affiliation(s)
- Sang-Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si 31116, Chungnam, Republic of Korea;
| | - Seung-Min Nam
- Department of Sports Rehabilitation and Exercise Management, Yeungnam University College, 170, Hyeonchung-ro, Nam-gu, Daegu 42415, Gyeongsangbuk-do, Republic of Korea;
| | - In-Hee Cho
- Department of Health, Graduate School, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si 31116, Chungnam, Republic of Korea
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Yeo SS, Park SY, Cho IH. Injury of the vestibulocerebellar tract in a patient with intracerebral hemorrhage: A case report. Neurosci Lett 2022; 783:136723. [PMID: 35691437 DOI: 10.1016/j.neulet.2022.136723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/26/2022] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The vestibulocerebellar tract (VCT) is an important pathway of the central vestibular system, and plays a role in posture reflexes as well as perception of the head and body motion in spatial direction. We report on a patient with intracerebral hemorrhage (ICH), who showed injury of the VCT, which was demonstrated by diffusion tensor imaging (DTI). CASE DESCRIPTION This study recruited an 81-year-old male patient presented with quadriparesis due to ICH on both cerebellar hemispheres and 5 control subjects. A patient had the dizziness that was occurred when he moved and the motor weakness in lower limb. The primary and secondary VCTs of a patient with total 25 score of Scale of the Assessment and Rating of Ataxia were reconstructed using DTI. RESULTS The results of DTI parameters of primary VCT showed that the tract volumes of primary VCT in both hemispheres of a patient showed significant decrease compared to those of control subjects. All of DTI parameters of ipsilateral secondary VCT in left hemisphere of a patient were within the reference range. Additionally, the ipsilateral secondary VCT in right hemisphere and the contralateral secondary VCTs in both hemispheres of a patient were not reconstructed. CONCLUSION We suggest that a patient's ataxia appears to be related to injury of the VCT. Therefore, we believe that the current study would be helpful in evaluating and clinical managing patients with ataxia following cerebellar injury.
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Affiliation(s)
- Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Republic of Korea.
| | - Seo Yoon Park
- Department of Physical Therapy, College of Health Sciences, Dankook University, Republic of Korea.
| | - In Hee Cho
- Department of Health, Graduate School, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungnam 31116, Republic of Korea.
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Gam BU, Cho IH, Yeo SS, Kwon JW, Jang SH, Oh S. Comparative study of vestibular projection pathway connectivity in cerebellar injury patients and healthy adults. BMC Neurosci 2022; 23:17. [PMID: 35317746 PMCID: PMC8939126 DOI: 10.1186/s12868-022-00702-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/07/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Cerebellar injury can not only cause gait and postural instability, nystagmus, and vertigo but also affect the vestibular system. However, changes in connectivity regarding the vestibular projection pathway after cerebellar injury have not yet been reported. Therefore, in the current study, we investigated differences in the connectivity of the vestibular projection pathway after cerebellar injury using diffusion tensor imaging (DTI) tractography. Methods We recruited four stroke patients with cerebellar injury. Neural connectivity in the vestibular nucleus (VN) of the pons and medulla oblongata in patients with cerebellar injury was measured using DTI. Connectivity was defined as the incidence of connection between the VN on the pons and medulla oblongata and target brain regions such as the cerebellum, thalamus, parieto-insular vestibular cortex (PIVC), and parietal lobe. Results At thresholds of 10 and 30, there was lower connectivity in the ipsilateral hemisphere between the VN at the medullar level and thalamus in the patients than in healthy adults. At a threshold of 1 and 10, the patient group showed lower VN connectivity with the PIVC than healthy adults. At a threshold of 1, VN connectivity with the parietal lobe in the contralateral hemisphere was lower in the patients than in healthy adults. Additionally, at a threshold of 30, VN connectivity at the pons level with the cerebellum was lower in healthy adults than in the patients. Conclusion Cerebellar injury seems to be associated with decreased vestibular projection pathway connectivity, especially in the ipsilateral thalamus, PIVC, and contralateral parietal lobe.
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Affiliation(s)
- Byeong Uk Gam
- Department of Health, Graduate School, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan, Chungnam, 31116, Republic of Korea
| | - In Hee Cho
- Department of Health, Graduate School, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan, Chungnam, 31116, Republic of Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, 119, Dandae‑ro, Dongnam-gu, Cheonan, Chungnam, 31116, Republic of Korea
| | - Jung Won Kwon
- Department of Physical Therapy, College of Health Sciences, Dankook University, 119, Dandae‑ro, Dongnam-gu, Cheonan, Chungnam, 31116, Republic of Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, 170, Hyeonchung-ro, Nam-gu, Daegu, 42415, Republic of Korea
| | - Seunghue Oh
- Department of Physical Therapy, Uiduk University, 261, Donghaedae-ro, Gangdong-myeon, Gyeongju, Gyeongsangbuk-do, 38004, Republic of Korea.
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Park SY, Yeo SS, Jang SH, Cho IH, Oh S. Associations Between Injury of the Parieto-Insular Vestibular Cortex and Changes in Motor Function According to the Recovery Process: Use of Diffusion Tensor Imaging. Front Neurol 2021; 12:740711. [PMID: 34819909 PMCID: PMC8607691 DOI: 10.3389/fneur.2021.740711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose: Parieto-insular vestibular cortex (PIVC) injury can cause symptoms such as abnormal gait and affects the integration and processing of sensory inputs contributing to self-motion perception. Therefore, this study investigated the association of the vestibular pathway in the gait and motor function recovery process in patients with PIVC injury using diffusion tensor imaging (DTI). Methods: We recruited 28 patients with stroke with only PIVC injury and reconstructed the PIVC using a 1.5-T scanner for DTI. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. The functional ambulatory category (FAC) test was conducted, and motricity index (MI) score was determined. These were conducted and determined at the start (phase 1), end of rehabilitation (phase 2), and during the follow-up 6 months after onset. Results: Although the tract volume of PIVC showed a decrease in subgroup A, all of DTI parameters were not different between two subgroups in affected side (p > 0.05). The results of MI and FAC were significantly different according to the recovery process (p < 0.05). In addition, FA of the PIVC showed a positive correlation with FAC in phase 2 of the recovery process on the affected side. On the unaffected side, FA of the PIVC showed a significant negative correlation with MI in all processes (p < 0.05). Conclusion: The degree of projection pathways to PIVC injury at onset time seems to be related to early restoration of gait function. Moreover, we believe that early detection of the projection pathway for PIVC injury using DTI would be helpful in the clinical evaluation and prediction of the prognosis of patients with PIVC injury.
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Affiliation(s)
- Seo Yoon Park
- Department of Physical Therapy, College of Health Sciences, Dankook University, Cheonan, South Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, Cheonan, South Korea
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, South Korea
| | - In Hee Cho
- Department of Health, Graduate School, Dankook University, Cheonan, South Korea
| | - Seunghue Oh
- Department of Physical Therapy, Yeungnam University College, Daegu, South Korea
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Jang SH, Bae CH, Kim JW, Kwon HG. Relationship between Dizziness and the Core Vestibular Projection Injury in Patients with Mild Traumatic Brain Injury. Diagnostics (Basel) 2021; 11:diagnostics11112070. [PMID: 34829416 PMCID: PMC8618454 DOI: 10.3390/diagnostics11112070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 12/18/2022] Open
Abstract
Some studies have reported that a core vestibular projection (CVP) injury is associated with dizziness following a brain injury using diffusion tensor tractography (DTT). On the other hand, there has been no DTT study on dizziness caused by a CVP injury in patients with mild traumatic brain injury (TBI). In this study, DTT was used to examine the relationship between dizziness and CVP injury in patients with mild TBI. Forty-three patients with mild TBI and twenty-nine normal subjects were recruited. The patients were classified into two groups based on the dizziness score: group A, patients with a dizziness score less than 2 on the sub-item score for dizziness in the Rivermead Post-concussion Symptoms Questionnaire; group B, patients with a dizziness score above 2. The tract volume (TV) in group B was significantly lower than group A and the control group (p < 0.05). By contrast, the TV in group A was similar to the control group (p > 0.05). Regarding the correlation, the dizziness score of all patients showed a strong negative correlation with the TV of the CVP (r = −0.711, p < 0.05). DTT revealed the CVP injury in patients with dizziness after mild TBI. In addition, the severity of dizziness of these patients was closely related to the injury severity of the CVP.
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Affiliation(s)
- Sung-Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Chang-Hoon Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Jae-Woon Kim
- Department of Radiology, College of Medicine, Yeungnam University, Daegu 42415, Korea;
| | - Hyeok-Gyu Kwon
- Department of Physical Therapy, College of Health Science, Eulji University, Sungnam-si 13135, Korea
- Correspondence: ; Tel.: +82-31-740-7127; Fax: +82-31-740-7367
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Jang SH, Oh S, Yeo SS. Lateral Medullary Syndrome Following Injury of Lateral Vestibulospinal Tract: Diffusion Tensor Imaging Study. J Stroke Cerebrovasc Dis 2020; 29:105252. [PMID: 33066903 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Unilateral lesions of vestibular nucleus can cause lateral medullary syndrome. Little is known about injury of medial and lateral vestibulospinal tract (VST) after dorsolateral medullary infarct. We investigated injury of the lateral VST in patients with typical central vestibular disorder using diffusion tensor tractography (DTT). METHODS Seven patients with lateral medullary syndrome and ten control subjects were recruited. For the medial VST, we determined seed region of interest (ROI) as medial vestibular nuclei of pons and target ROI on posteromedial medulla. For the lateral VST, the seed ROI was placed on lateral vestibular nuclei of pons, and the target ROI on posterolateral medulla. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. RESULT Reconstructed lateral VST on both sides had significantly lower FA values in patients than controls (p<0.05). Tract volume of lateral VST in affected side was significantly lower than unaffected side and control group (p<0.05). However, no DTI parameters of the medial VST differed between patients and controls (p>0.05). CONCLUSION Injury of the lateral VST was demonstrated in patients with lateral vestibular syndrome following dorsolateral medullary infarct. Analysis of the lateral VST using DTT would be helpful in evaluation of patients with lateral medullary syndrome.
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Affiliation(s)
- Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, South Korea
| | - Seunghue Oh
- Department of Physical Therapy, Graduate School, Dankook University, South Korea
| | - Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University, South Korea.
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Effects of injuries to descending motor pathways on restoration of gait in patients with pontine hemorrhage. J Stroke Cerebrovasc Dis 2020; 29:104857. [PMID: 32409256 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104857] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND PURPOSE Gait disturbance due to injuries of the descending motor pathway, including corticospinal tract (CST), corticoreticular pathway (CRP), and medial and lateral vestibulospinal tracts (VSTs), are commonly encountered disabling sequelae of pontine hemorrhage. We investigated relations between changes in the CST, CRP, and medial and lateral VST and corresponding changes in gait function in patients with pontine hemorrhage. METHOD Nine consecutive stroke patients with pontine hemorrhage, and 6 age-matched normal subjects were recruited. Four patients were allocated to group A (can't walk independently) and 5 to group B (can walk independently). Diffusion tensor imaging (DTI) data were acquired twice at acute to subacute stage and chronic stage after stroke onset. Diffusion tensor tractography (DTT) was used to reconstruct CST, CRP, medial and lateral VST. RESULT The CRP shows a significantly different between groups A and B in both initial and follow up DTT (p > 0.05). In contrast, CST, medial VST and lateral VST did not show a significant difference (p > 0.05). Regarding DTI parameters of CRPs in group A, percentages of patients with fractional anisotropy (FA) and mean diffusivity (MD) values more than two standard deviation from normal were higher by follow up DTI than by initial DTI, however, the CRPs in group B only showed increased abnormal range of MD. CONCLUSIONS The CST does not play an essential role in recovery of independent walking and vestibulospinal tracts may not crucially affect recovery of independent walking in patients with pontine hemorrhage. In contrast, and intact CRP or changes of the CRP integrity appear to be related to the recovery of gait function.
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Three-Dimensional Identification of the Medial Longitudinal Fasciculus in the Human Brain: A Diffusion Tensor Imaging Study. J Clin Med 2020; 9:jcm9051340. [PMID: 32375364 PMCID: PMC7290796 DOI: 10.3390/jcm9051340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/13/2020] [Accepted: 04/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The medial longitudinal fasciculus (MLF) interacts with eye movement control circuits involved in the adjustment of horizontal, vertical, and torsional eye movements. In this study, we attempted to identify and investigate the anatomical characteristics of the MLF in human brain, using probabilistic diffusion tensor imaging (DTI) tractography. Methods: We recruited 31 normal healthy adults and used a 1.5-T scanner for DTI. To reconstruct MLFs, a seed region of interest (ROI) was placed on the interstitial nucleus of Cajal at the midbrain level. A target ROI was located on the MLF of the medulla in the reticular formation of the medulla. Mean values of fractional anisotropy, mean diffusivity, and tract volumes of MLFs were measured. Results: The component of the MLF originated from the midbrain MLF, descended through the posterior side of the medial lemniscus (ML) and terminated on the MLF of medulla on the posterior side of the ML in the medulla midline. DTI parameters of right and left MLFs were not significantly different. Conclusion: The tract of the MLF in healthy brain was identified by probabilistic DTI tractography. We believe this study will provide basic data and aid future comparative research on lesion or age-induced MLF changes.
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Kwon HG, Chang CH, Jang SH. Diagnosis of Dizziness Due to a Core Vestibular Projection Injury in a Patient with Intracerebral Hemorrhage. Diagnostics (Basel) 2020; 10:diagnostics10040220. [PMID: 32326449 PMCID: PMC7235721 DOI: 10.3390/diagnostics10040220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 11/18/2022] Open
Abstract
Herein, we present a patient diagnosed with dizziness due to a core vestibular projection injury following intracerebral hemorrhage (ICH). A 51-year-old female patient underwent conservative management for a spontaneous ICH in the left hemisphere (mainly affecting the basal ganglia and insular cortex). When she visited the rehabilitation department of the university hospital at two years after the ICH onset, she advised of the presence of moderate dizziness (mainly, light-headedness) that started after ICH onset. She mentioned that her dizziness had decreased slightly over time. No abnormality was observed in the vestibular system of either ear on physical examination by an otorhinolaryngologist. However, diffusion tensor tractography results showed that the core vestibular projection in the left hemisphere was discontinued at the basal ganglia level compared with the patient’s right core vestibular projection and that of a normal subject. Therefore, it appears that the dizziness in this patient can be ascribed to a left core vestibular projection injury.
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Affiliation(s)
- Hyeok Gyu Kwon
- Department of Physical Therapy, College of Health Science, Eulji University, Sungnam 13135, Korea;
| | - Chul Hoon Chang
- Department of Neurosurgery, College of Medicine Yeungnam University, Daegu 42415, Korea;
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu 42415, Korea
- Correspondence: ; Tel.: +82-53-620-4098; Fax: +82-53-625-3508
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Yeo SS, Jang SH, Oh S, Kwon JW. Role of diffusion tensor imaging in analyzing the neural connectivity of the parieto-insular vestibular cortex in pusher syndrome: As case report. Medicine (Baltimore) 2020; 99:e19835. [PMID: 32312005 PMCID: PMC7220494 DOI: 10.1097/md.0000000000019835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Pusher syndrome is a disorder of postural control. It is associated with unilateral lesions on central vestibular system. In the current study, we attempted to identify and investigate neural connectivity of the parieto-insular vestibular cortex in a patient with pusher syndrome, using diffusion tensor imaging. PATIENT CONCERNS A 60-year-old male patient had left hemiplegia due to an infarction on right premotor cortex, primary motor cortex, corona radiata and temporal and occipital lobe. The patient had severe motor weakness in left upper and lower limb, left side neglect and significant pusher syndrome. DIAGNOSIS Patient was diagnosed with left hemiplegia due to an infarction in the right middle cerebral artery territory at the neurology department of a university hospital. INTERVENTIONS One patient and 5 control subjects of similar age participated. Diffusion tensor imaging data were acquired at 4-month and 12-month after the initial injury. OUTCOMES Fractional anisotropy, mean diffusivity, and tract volume (TV) were measured. TV values in both affected and unaffected hemispheres of the patient were significantly decreased at 4-month compared to those of control subjects. In the unaffected hemisphere of the patient, TV value showed significant increase at 12-month compared to that at 4-month. Although the TV value at 12-month of the affected hemisphere was out of reference range, TV was considerably increased compared to that at 4-month. Mean values for fractional anisotropy or mean diffusivity in 2 hemispheres did not show significant difference compared to those of control subjects regardless of month. LESSONS Restoration of an injured projection pathway between the vestibular nuclei and parieto-insular vestibular cortex with recovery of pusher syndrome was found in a patient with stroke.
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Affiliation(s)
- Sang Seok Yeo
- Department of Physical Therapy, College of Health Sciences, Dankook University
| | - Sung Ho Jang
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University
| | - Seunghue Oh
- Department of Health, Graduate School, Dankook University, Republic of Kore
| | - Jung Won Kwon
- Department of Physical Therapy, College of Health Sciences, Dankook University
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Associations between Age-Related Changes in the Core Vestibular Projection Pathway and Balance Ability: A Diffusion Tensor Imaging Study. Behav Neurol 2020; 2020:2825108. [PMID: 32104515 PMCID: PMC7036129 DOI: 10.1155/2020/2825108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 02/06/2023] Open
Abstract
Objective We investigated the changes of the vestibulospinal tract (VST) and parietoinsular vestibular cortex (PIVC) using diffusion tensor imaging (DTI) and relation to balance between old and young healthy adults. Methods This study recruited eleven old adults (6 males, 5 females; mean age 63.36 ± 4.25 years) and 12 young adults (7 males, 5 females; mean age 28.42 ± 4.40 years). The lateral and medial VST and PIVC were reconstructed using DTI. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. The six-minute walk test (6-MWT), the timed up and go test (TUG), and the Berg balance scale (BBS) were conducted. Spatiotemporal parameters during tandem gait and values of sway during one-leg standing using the wearable sensors were measured. All parameters between two groups were analyzed by the Mann-Whitney U test and independent t-test. Results Statistically significant decrease in old adults was detected in the tract volume of lateral (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (. Conclusion The results suggested that there was a relationship between DTI parameters in the vestibular neural pathway and balance according to aging.
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Mitsutake T, Sakamoto M, Ueta K, Horikawa E. Standing postural stability during galvanic vestibular stimulation is associated with the motor function of the hemiplegic lower extremity post-stroke. Top Stroke Rehabil 2019; 27:110-117. [PMID: 31618124 DOI: 10.1080/10749357.2019.1667662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The vestibular system is profoundly involved in standing postural stability. Patients with post-stroke hemiparesis have poor postural control function; nevertheless, it is unclear as to how the vestibular system affects postural control after stroke.Objectives: The purpose of this study was to quantitatively evaluate the relationship between galvanic whole-body sway responses and motor function of the hemiplegic lower extremity post-stroke.Methods: Thirty stroke patients and 49 healthy controls underwent standing body sway tests to examine postural control function during vestibular stimulation. Postural stabilization was measured using a C7-mounted accelerometer during galvanic vestibular stimulation. Postural stability was assessed during stimulation while quietly standing with eyes closed. For the stroke group, lower extremity function was measured using the Fugl-Meyer Assessment scale (FMA-LE).Results: The standing body sway test scores during stimulation were lower in the stroke group than the control group (p = .010). In the stroke group, correlation analysis demonstrated that the standing body sway response score was significantly associated with the FMA-LE (r = 0.374, p = .021).Conclusions: Motor dysfunction directly causes standing postural instability during vestibular stimulation, even though sensory information suggests normal peripheral vestibular function. Therefore, motor dysfunction of the hemiplegic lower extremity might lead to inhibition of normal standing postural stability.
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Affiliation(s)
- Tsubasa Mitsutake
- Department of Physical Therapy, Faculty of Medical Science, Fukuoka International University of Health and Welfare, Fukuoka, Japan
| | - Maiko Sakamoto
- Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kozo Ueta
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Etsuo Horikawa
- Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Saga, Japan
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Molina F, Lomas-Vega R, Obrero-Gaitán E, Rus A, Almagro DR, Del-Pino-Casado R. Misperception of the subjective visual vertical in neurological patients with or without stroke: A meta-analysis. NeuroRehabilitation 2019; 44:379-388. [PMID: 31227659 DOI: 10.3233/nre-182642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The interpretation of the verticality of the environment is crucial for a proper body balance. The subjective visual vertical test (SVV) is a widely used method to determine the visual perception of the verticality, whose alteration has been related with poor functional status. OBJECTIVE To analyze the visual perception of the verticality in neurological patients in comparison with healthy controls. METHODS We searched PubMed, Scopus, and Scielo from the start of the databases until October 2017 and manually searched the reference lists of studies comparing SVV values between neurological patients and controls. Standardized mean difference (SMD) and subgroup analysis were used to analyze differences between neurological patients and healthy subjects and between stroke and non-stroke patients, respectively. RESULTS A total of 1,916 subjects from 31 studies were included. Neurological patients misestimate the true vertical in comparison with controls (SMD = 1.05; 95% CI: 0.81, 1.28). The misperception of the verticality was higher in stroke patients (SMD = 1.35; 95% CI: 1.02, 1.68) than in patients with other neurological conditions (SMD = 0.48; 95% CI: 0.29, 0.68). CONCLUSIONS Neurological patients showed a misperception of the verticality, estimated using the SVV. The neurological pathology that most alters the SVV is stroke.
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Affiliation(s)
- Francisco Molina
- Department of Health Science, University of Jaén, Paraje Las Lagunillas s/n, Jaén, Spain
| | - Rafael Lomas-Vega
- Department of Health Science, University of Jaén, Paraje Las Lagunillas s/n, Jaén, Spain
| | - Esteban Obrero-Gaitán
- Department of Health Science, University of Jaén, Paraje Las Lagunillas s/n, Jaén, Spain
| | - Alma Rus
- Department of Cell Biology, University of Granada, Campus Fuentenueva, Granada, Spain
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