Global orientation in space and the lateralization of brain functions

Visual Field Deficits in Albinism in Comparison to Idiopathic Infantile Nystagmus

Purpose

This is the first systematic comparison of visual field (VF) deficits in people with albinism (PwA) and idiopathic infantile nystagmus (PwIIN) using static perimetry. We also compare best-corrected visual acuity (BCVA) and optical coherence tomography measures of the fovea, parafovea, and circumpapillary retinal nerve fiber layer in PwA.

Methods

VF testing was performed on 62 PwA and 36 PwIIN using a Humphrey Field Analyzer (SITA FAST 24-2). Mean detection thresholds for each eye were calculated, along with quadrants and central measures. Retinal layers were manually segmented in the macular region.

Results

Mean detection thresholds were significantly lower than normative values for PwA (-3.10 ± 1.67 dB, P << 0.0001) and PwIIN (-1.70 ± 1.54 dB, P < 0.0001). Mean detection thresholds were significantly lower in PwA compared to PwIIN (P < 0.0001) and significantly worse for left compared to right eyes in PwA (P = 0.0002) but not in PwIIN (P = 0.37). In PwA, the superior nasal VF was significantly worse than other quadrants (P < 0.05). PwIIN appeared to show a mild relative arcuate scotoma. In PwA, central detection thresholds were correlated with foveal changes in the inner and outer retina. VF was strongly correlated to BCVA in both groups.

Conclusions

Clear peripheral and central VF deficits exist in PwA and PwIIN, and static VF results need to be interpreted with caution clinically. Since PwA exhibit considerably lower detection thresholds compared to PwIIN, VF defects are unlikely to be due to nystagmus in PwA. In addition to horizontal VF asymmetry, PwA exhibit both vertical and interocular asymmetries, which needs further exploration.

Localization of Vestibular Cortex Using Electrical Cortical Stimulation: A Systematic Literature Review

The vestibular system plays a fundamental role in body orientation, posture control, and spatial and body motion perception, as well as in gaze and eye movements. We aimed to review the current knowledge regarding the location of the cortical and subcortical areas, implicated in the processing of vestibular stimuli. The search was performed in PubMed and Scopus. We focused on studies reporting on vestibular manifestations after electrical cortical stimulation. A total of 16 studies were finally included. Two main types of vestibular responses were elicited, including vertigo and perception of body movement. The latter could be either rotatory or translational. Electrical stimulation of the temporal structures elicited mainly vertigo, while stimulation of the parietal lobe was associated with perceptions of body movement. Stimulation of the occipital lobe produced vertigo with visual manifestations. There was evidence that the vestibular responses became more robust with increasing current intensity. Low-frequency stimulation proved to be more effective than high-frequency in eliciting vestibular responses. Numerous non-vestibular responses were recorded after stimulation of the vestibular cortex, including somatosensory, viscero-sensory, and emotional manifestations. Newer imaging modalities such as functional MRI (fMRI), Positron Emission Tomography (PET), SPECT, and near infra-red spectroscopy (NIRS) can provide useful information regarding localization of the vestibular cortex.

Association between Gray and White Matter Lesions and Its Involvement in Clinical Symptoms of Alzheimer's-Type Dementia

BACKGROUND

Not only gray matter lesions (GMLs) but also white matter lesions (WMLs) can play important roles in the pathology of Alzheimer's disease (AD). The progression of cognitive impairment (CI) and behavioral and psychological symptoms of dementia (BPSD) might be caused by a concerted effect of both GML and WML.

OBJECTIVE

This study aimed to investigate the association between GML and WML and how they are involved in the symptoms of CI and BPSD in dementia patients by means of imaging technology.

METHODS

Patients in our memory clinic, who were diagnosed with AD-type dementia or amnestic mild cognitive impairment (aMCI) and had undergone both single-photon emission computed tomography (SPECT) and brain MRI, were consecutively enrolled (n = 156; 61 males and 95 females; 79.8 ± 7.4 years old). Symptoms of CI and BPSD were obtained from patients' medical records. For the analysis of GMLs and WMLs, SPECT data and MRI T1-weighted images were used, respectively. This study followed the Declaration of Helsinki, and all procedures were approved by the institutional ethics committee.

RESULTS

According to a multivariate analysis, disorientation and disturbed attention demonstrated a relationship between the precuneus and WMLs in both hemispheres. Hyperactivity in BPSD showed multiple correlations between GMLs on both sides of the frontal cortex and WMLs. Patients with aMCI presented more multiple correlations between GMLs and WMLs compared with those with AD-type dementia regarding dementia symptoms including BPSD.

CONCLUSION

The interaction between GMLs and WMLs may vary depending on the symptoms of CI and BPSD. Hyperactivity in BPSD may be affected by the functional relationship between GMLs and WMLs in the left and right hemispheres. The correlation between GMLs and WMLs may be changing in AD-type dementia and aMCI.

Vestibular perceptual testing from lab to clinic: a review

Not all dizziness presents as vertigo, suggesting other perceptual symptoms for individuals with vestibular disease. These non-specific perceptual complaints of dizziness have led to a recent resurgence in literature examining vestibular perceptual testing with the aim to enhance clinical diagnostics and therapeutics. Recent evidence supports incorporating rehabilitation methods to retrain vestibular perception. This review describes the current field of vestibular perceptual testing from scientific laboratory techniques that may not be clinic friendly to some low-tech options that may be more clinic friendly. Limitations are highlighted suggesting directions for additional research.

Visuospatial cognition in acute unilateral peripheral vestibulopathy

Background

This study aims to investigate the presence of spatial cognitive impairments in patients with acute unilateral peripheral vestibulopathy (vestibular neuritis, AUPV) during both the acute phase and the recovery phase.

Methods

A total of 72 AUPV patients (37 with right-sided AUPV and 35 with left-sided AUPV; aged 34-80 years, median 60.5; 39 males, 54.2%) and 35 healthy controls (HCs; aged 43-75 years, median 59; 20 males, 57.1%) participated in the study. Patients underwent comprehensive neurotological assessments, including video-oculography, video head impulse and caloric tests, ocular and cervical vestibular-evoked myogenic potentials, and pure-tone audiometry. Additionally, the Visual Object and Space Perception (VOSP) battery was used to evaluate visuospatial perception, while the Block design test and Corsi block-tapping test assessed visuospatial memory within the first 2 days (acute phase) and 4 weeks after symptom onset (recovery phase).

Results

Although AUPV patients were able to successfully perform visuospatial perception tasks within normal parameters, they demonstrated statistically worse performance on the visuospatial memory tests compared to HCs during the acute phase. When comparing right versus left AUPV groups, significant decreased scores in visuospatial perception and memory were observed in the right AUPV group relative to the left AUPV group. In the recovery phase, patients showed substantial improvements even in these previously diminished visuospatial cognitive performances.

Conclusion

AUPV patients showed different spatial cognition responses, like spatial memory, depending on the affected ear, improving with vestibular compensation over time. We advocate both objective and subjective visuospatial assessments and the development of tests to detect potential cognitive deficits after unilateral vestibular impairments.

Uncorrelated bilateral cortical input becomes timed across hippocampal subfields for long waves whereas gamma waves are largely ipsilateral

The role of interhemispheric connections along successive segments of cortico-hippocampal circuits is poorly understood. We aimed to obtain a global picture of spontaneous transfer of activity during non-theta states across several nodes of the bilateral circuit in anesthetized rats. Spatial discrimination techniques applied to bilateral laminar field potentials (FP) across the CA1/Dentate Gyrus provided simultaneous left and right readouts in five FP generators that reflect activity in specific hippocampal afferents and associative pathways. We used a battery of correlation and coherence analyses to extract complementary aspects at different time scales and frequency bands. FP generators exhibited varying bilateral correlation that was high in CA1 and low in the Dentate Gyrus. The submillisecond delays indicate coordination but not support for synaptic dependence of one side on another. The time and frequency characteristics of bilateral coupling were specific to each generator. The Schaffer generator was strongly bilaterally coherent for both sharp waves and gamma waves, although the latter maintained poor amplitude co-variation. The lacunosum-moleculare generator was composed of up to three spatially overlapping activities, and globally maintained high bilateral coherence for long but not short (gamma) waves. These two CA1 generators showed no ipsilateral relationship in any frequency band. In the Dentate Gyrus, strong bilateral coherence was observed only for input from the medial entorhinal areas, while those from the lateral entorhinal areas were largely asymmetric, for both alpha and gamma waves. Granger causality testing showed strong bidirectional relationships between all homonymous bilateral generators except the lateral entorhinal input and a local generator in the Dentate Gyrus. It also revealed few significant relationships between ipsilateral generators, most notably the anticipation of lateral entorhinal cortex toward all others. Thus, with the notable exception of the lateral entorhinal areas, there is a marked interhemispheric coherence primarily for slow envelopes of activity, but not for pulse-like gamma waves, except in the Schafer segment. The results are consistent with essentially different streams of activity entering from and returning to the cortex on each side, with slow waves reflecting times of increased activity exchange between hemispheres and fast waves generally reflecting ipsilateral processing.

F = ma. Is the macaque brain Newtonian?

Intuitive Physics, the ability to anticipate how the physical events involving mass objects unfold in time and space, is a central component of intelligent systems. Intuitive physics is a promising tool for gaining insight into mechanisms that generalize across species because both humans and non-human primates are subject to the same physical constraints when engaging with the environment. Physical reasoning abilities are widely present within the animal kingdom, but monkeys, with acute 3D vision and a high level of dexterity, appreciate and manipulate the physical world in much the same way humans do.

Comparison of Electroencephalogram Power Spectrum Characteristics of Left and Right Dragon Boat Athletes after 1 km of Rowing

Purpose: This study aimed to detect differences in post-exercise brain activity between the left and right paddlers due to exercise by analyzing the resting-state electroencephalogram (EEG) power spectrum before and after exercise. Methods: Twenty-one right paddlers and twenty-two left paddlers completed a 1 km all-out test on a dragon boat ergometer, and their heart rate and exercise time were recorded. EEG signals were collected from superficial brain layers before and after exercise; then, the EEG power spectrum was extracted and compared in different frequency bands. In addition, the degree of lateralization in each brain region was assessed by the asymmetry index. Results: There was no significant difference in the power spectrum values and asymmetry indices between the left and right paddlers before rowing (p ˃ 0.05). However, after rowing, the left-paddlers group had significantly higher spectral power values in θ and α bands than the right-paddlers group (p < 0.05), and brain lateralization in both groups of athletes occurred mainly in the ipsilateral hemisphere of the frontal and central regions. Conclusion: The 1 km of rowing induced more brain activation in the left paddlers, and both left and right paddlers showed functional aggregation of hemispheric lateralization.

Hippocampal volume in patients with bilateral and unilateral peripheral vestibular dysfunction

Previous studies have found that peripheral vestibular dysfunction is associated with altered volumes in different brain structures, especially in the hippocampus. However, published evidence is conflicting. Based on previous findings, we compared hippocampal volume, as well as supramarginal, superior temporal, and postcentral gyrus in a sample of 55 patients with different conditions of peripheral vestibular dysfunction (bilateral, chronic unilateral, acute unilateral) to 39 age- and sex-matched healthy controls. In addition, we explored deviations in gray-matter volumes in hippocampal subfields. We also analysed correlations between morphometric data and visuo-spatial performance. Patients with vestibular dysfunction did not differ in total hippocampal volume from healthy controls. However, a reduced volume in the right presubiculum of the hippocampus and the left supramarginal gyrus was observed in patients with chronic and acute unilateral vestibular dysfunction, but not in patients with bilateral vestibular dysfunction. No association of altered volumes with visuo-spatial performance was found. An asymmetric vestibular input due to unilateral vestibular dysfunction might lead to reduced central brain volumes that are involved in vestibular processing.

Neurosensory development of the four brainstem-projecting sensory systems and their integration in the telencephalon

Somatosensory, taste, vestibular, and auditory information is first processed in the brainstem. From the brainstem, the respective information is relayed to specific regions within the cortex, where these inputs are further processed and integrated with other sensory systems to provide a comprehensive sensory experience. We provide the organization, genetics, and various neuronal connections of four sensory systems: trigeminal, taste, vestibular, and auditory systems. The development of trigeminal fibers is comparable to many sensory systems, for they project mostly contralaterally from the brainstem or spinal cord to the telencephalon. Taste bud information is primarily projected ipsilaterally through the thalamus to reach the insula. The vestibular fibers develop bilateral connections that eventually reach multiple areas of the cortex to provide a complex map. The auditory fibers project in a tonotopic contour to the auditory cortex. The spatial and tonotopic organization of trigeminal and auditory neuron projections are distinct from the taste and vestibular systems. The individual sensory projections within the cortex provide multi-sensory integration in the telencephalon that depends on context-dependent tertiary connections to integrate other cortical sensory systems across the four modalities.

Changes in Cognitive Functioning After Surgical Resection of Language-related, Eloquent-area, High-grade Gliomas Under Awake Craniotomy

BACKGROUND

Dominant-hemisphere tumors, especially gliomas, as infiltrative tumors, frequently affect cognitive functioning. Establishing a balance between extensive resection, which is proven to result in longer survival, and less extensive resection, in order to maintain more cognitive abilities, is challenging.

OBJECTIVE

To evaluate changes in cognitive functioning before and after surgical resection of language-related, eloquent-area, high-grade gliomas under awake craniotomy.

METHOD

We provided individuals with newly diagnosed high-grade gliomas of the language-related eloquent areas with the same standard of care, including surgical resection of the glioma using intraoperative sensory-motor and cognitive mapping under awake craniotomy, and the same protocol for chemoradiotherapy. Cognitive functioning was assessed using Addenbrooke's Cognitive Examination-Revised (ACE-R) at four time points (preoperatively, early after surgery, and 3 and 6 months postoperatively).

RESULTS

The preoperative evaluation revealed a range of cognitive impairments in 70.7% of the individuals, affecting all of the cognitive subdomains (mostly attention and visuospatial abilities). Overall cognitive functioning (ie, ACE-R score) dropped by 13.5% (P= 0.169) early postoperatively. At the 3-month evaluation, an average of 15.3% (P= 0.182) recovery in cognitive functioning was observed (mostly in verbal fluency: 39.1%). This recovery improved further, reaching 29% (P< 0.001) at the 6-month evaluation. The greatest improvement occurred in verbal fluency: 68.8%,P= 0.001.

CONCLUSION

Extensive resection of eloquent-area gliomas with the aid of modern neuroimaging and neuromonitoring techniques under awake craniotomy is possible without significant long-term cognitive sequela.

Navigation strategies in patients with vestibular loss tested in a virtual reality T-maze

During navigation, humans mainly rely on egocentric and allocentric spatial strategies, two different frames of reference working together to build a coherent representation of the environment. Spatial memory deficits during navigation have been repeatedly reported in patients with vestibular disorders. However, little is known about how vestibular disorders can change the use of spatial navigation strategies. Here, we used a new reverse T-maze paradigm in virtual reality to explore whether vestibular loss specifically modifies the use of egocentric or allocentric spatial strategies in patients with unilateral (n = 23) and bilateral (n = 23) vestibular loss compared to healthy volunteers (n = 23) matched for age, sex and education level. Results showed that the odds of selecting and using a specific strategy in the T-maze were significantly reduced in both unilateral and bilateral vestibular loss. An exploratory analysis suggests that only right vestibular loss decreased the odds of adopting a spatial strategy, indicating an asymmetry of vestibular functions. When considering patients who used strategies to navigate, we observed that a bilateral vestibular loss reduced the odds to use an allocentric strategy, whereas a unilateral vestibular loss decreased the odds to use an egocentric strategy. Age was significantly associated with an overall lower chance to adopt a navigation strategy and, more specifically, with a decrease in the odds of using an allocentric strategy. We did not observe any sex difference in the ability to select and use a specific navigation strategy. Findings are discussed in light of previous studies on visuo-spatial abilities and studies of vestibulo-hippocampal interactions in peripheral vestibular disorders. We discuss the potential impact of the history of the disease (chronic stage in patients with a bilateral vestibulopathy vs. subacute stage in patients with a unilateral vestibular loss), of hearing impairment and non-specific attentional deficits in patients with vestibular disorders.

The Differential Effects of Acute Right- vs. Left-Sided Vestibular Deafferentation on Spatial Cognition in Unilateral Labyrinthectomized Mice

This study aimed to investigate the disparity in locomotor and spatial memory deficits caused by left- or right-sided unilateral vestibular deafferentation (UVD) using a mouse model of unilateral labyrinthectomy (UL) and to examine the effects of galvanic vestibular stimulation (GVS) on the deficits over 14 days. Five experimental groups were established: the left-sided and right-sided UL (Lt.-UL and Rt.-UL) groups, left-sided and right-sided UL with bipolar GVS with the cathode on the lesion side (Lt.-GVS and Rt.-GVS) groups, and a control group with sham surgery. We assessed the locomotor and cognitive-behavioral functions using the open field (OF), Y maze, and Morris water maze (MWM) tests before (baseline) and 3, 7, and 14 days after surgical UL in each group. On postoperative day (POD) 3, locomotion and spatial working memory were more impaired in the Lt.-UL group compared with the Rt.-UL group (p < 0.01, Tamhane test). On POD 7, there was a substantial difference between the groups; the locomotion and spatial navigation of the Lt.-UL group recovered significantly more slowly compared with those of the Rt.-UL group. Although the differences in the short-term spatial cognition and motor coordination were resolved by POD 14, the long-term spatial navigation deficits assessed by the MWM were significantly worse in the Lt.-UL group compared with the Rt.-UL group. GVS intervention accelerated the vestibular compensation in both the Lt.-GVS and Rt.-GVS groups in terms of improvement of locomotion and spatial cognition. The current data imply that right- and left-sided UVD impair spatial cognition and locomotion differently and result in different compensatory patterns. Sequential bipolar GVS when the cathode (stimulating) was assigned to the lesion side accelerated recovery for UVD-induced spatial cognition, which may have implications for managing the patients with spatial cognitive impairment, especially that induced by unilateral peripheral vestibular damage on the dominant side.

Case Report: Visual Deprivation in Pusher Syndrome Complicated by Hemispatial Neglect After Basal Ganglia Stroke

We aimed to explore whether motor function and activities of daily life (ADL) could be improved with the application of visual deprivation in two patients with Pusher syndrome complicated by hemispatial neglect after right basal ganglia stroke. We assessed two stroke patients suffering from severe motor disturbances, both tilting heavily to the left, with diagnoses of Pusher syndrome and left hemispatial neglect. Vision in the left eye was deprived using patches during clinical rehabilitation. Motor function promotion was confirmed using the Burke Lateropulsion Scale (BLS), Fugl–Meyer Balance Scale (FMBS), and Holden grade (HG), while the Barthel index (BI) assessed ADL immediately and 1 week after intervention. Both patients regained standing balance immediately using visual deprivation, as well as walking ability, although both scored 0 on the FMBS and HG. After 1 week of treatment, one patient increased to 11 and 3 on the FMBS and HG, respectively, while the BLS score decreased from 12 to 2, and the ADL increased from 23 to 70. The other patient demonstrated increases to 10 and 3 on the FMBS and HG, respectively, with the BLS decreasing from 13 to 3, and the ADL increasing from 25 to 60. Therefore, in the rehabilitation treatment of Pusher syndrome complicated by hemispatial neglect due to basal ganglia stroke, visual deprivation can significantly improve motor function and shorten the treatment course.

Vestibular-Evoked Cerebral Potentials

The human vestibular cortex has mostly been approached using functional magnetic resonance imaging and positron emission tomography combined with artificial stimulation of the vestibular receptors or nerve. Few studies have used electroencephalography and benefited from its high temporal resolution to describe the spatiotemporal dynamics of vestibular information processing from the first milliseconds following vestibular stimulation. Evoked potentials (EPs) are largely used to describe neural processing of other sensory signals, but they remain poorly developed and standardized in vestibular neuroscience and neuro-otology. Yet, vestibular EPs of brainstem, cerebellar, and cortical origin have been reported as early as the 1960s. This review article summarizes and compares results from studies that have used a large range of vestibular stimulation, including natural vestibular stimulation on rotating chairs and motion platforms, as well as artificial vestibular stimulation (e.g., sounds, impulsive acceleration stimulation, galvanic stimulation). These studies identified vestibular EPs with short latency (<20 ms), middle latency (from 20 to 50 ms), and late latency (>50 ms). Analysis of the generators (source analysis) of these responses offers new insights into the neuroimaging of the vestibular system. Generators were consistently found in the parieto-insular and temporo-parietal junction-the core of the vestibular cortex-as well as in the prefrontal and frontal areas, superior parietal, and temporal areas. We discuss the relevance of vestibular EPs for basic research and clinical neuroscience and highlight their limitations.

Vibration of calf muscles has reverse effects on right and left ankle proprioception in high and low proprioceptive performer groups

PURPOSE

Previous research has found hemispheric asymmetries in the utilization of proprioceptive information. It is undetermined, however, if there is any change in asymmetry in proprioceptive function when external stimulation, such as vibration, is presented. The present study was to investigate the immediate effects of vibration stimulation (VS) on bilateral ankle proprioception.

MATERIALS AND METHODS

Forty-six recreational male basketball players were included. Proprioception was assessed by using the active movement extent discrimination apparatus (AMEDA) in standing, and vibration was provided by using a vibrating form roller on the peroneal or gastrocnemius muscles.

RESULTS

When participants were divided into high score and low score groups, according to the median of the baseline proprioceptive performance, VS (irrespective of whether vibrating the peroneal or gastrocnemius muscles) significantly improved left non-dominant ankle proprioception in the low proprioceptive performer group (p = 0.019), while significantly deteriorated right dominant ankle proprioception in the high proprioceptive performer group (p = 0.011).

CONCLUSIONS

The results found that external stimuli reversely affect proprioception in better and worse performing groups. This suggests that there are differences in the processing of external stimulus signals on different bilateral hemispheres and in different groups (high score vs low score groups), which may be related to hemispheric asymmetry and stochastic resonance. Therefore, it is necessary to explore more specific interventions in the future.

Dynamic whole-brain metabolic connectivity during vestibular compensation in the rat

Unilateral damage to the inner ear results in an acute vestibular syndrome, which is compensated within days to weeks due to adaptive cerebral plasticity. This process, called central vestibular compensation (VC), involves a wide range of functional and structural mechanisms at the cellular and network level. The short-term dynamics of whole-brain functional network recruitment and recalibration during VC has not been depicted in vivo. The purpose of this study was to investigate the interplay of separate and distinct brain regions and in vivo networks in the course of VC by sequential [¹⁸F]-FDG-PET-based statistical and graph theoretical analysis with the aim of revealing the metabolic connectome before and 1, 3, 7, and 15 days post unilateral labyrinthectomy (UL) in the rat. Temporal changes in metabolic brain connectivity were determined by Pearson's correlation (|r| > 0.5, p < 0.001) of regional cerebral glucose metabolism (rCGM) in 57 segmented brain regions. Metabolic connectivity analysis was compared to univariate voxel-wise statistical analysis of rCGM over time and to behavioral scores of static and dynamic sensorimotor recovery. Univariate statistical analysis revealed an ipsilesional relative rCGM decrease (compared to baseline) and a contralesional rCGM increase in vestibular and limbic networks and an increase in bilateral cerebellar and sensorimotor networks. Quantitative analysis of the metabolic connections showed a maximal increase from baseline to day 3 post UL (interhemispheric: 2-fold, ipsilesional: 3-fold, contralesional: 12-fold) and a gradual decline until day 15 post UL, which paralleled the dynamics of vestibular symptoms. In graph theoretical analysis, an increase in connectivity occurred especially within brain regions associated with brainstem-cerebellar and thalamocortical vestibular networks and cortical sensorimotor networks. At the symptom peak (day 3 post UL), brain networks were found to be organized in large ensembles of distinct and highly connected hubs of brain regions, which separated again with progressing VC. Thus, we found rapid changes in network organization at the subcortical and cortical level and in both hemispheres, which may indicate an initial functional substitution of vestibular loss and subsequent recalibration and reorganization of sensorimotor networks during VC.

Structural connectome and connectivity lateralization of the multimodal vestibular cortical network

Unlike other sensory systems, the structural connectivity patterns of the human vestibular cortex remain a matter of debate. Based on their functional properties and hypothesized centrality within the vestibular network, the ‘core’ cortical regions of this network are thought to be areas in the posterior peri-sylvian cortex, in particular the retro-insula (previously named the posterior insular cortex-PIC), and the subregion OP2 of the parietal operculum.

To study the vestibular network, structural connectivity matrices from n=974 healthy individuals drawn from the public Human Connectome Project (HCP) repository were estimated using multi-shell diffusion-weighted data followed by probabilistic tractography and spherical-deconvolution informed filtering of tractograms in combination with subject-specific grey-matter parcellations. Weighted graph-theoretical measures, modularity, and ‘hubness’ of the multimodal vestibular network were then estimated, and a structural lateralization index was defined in order to assess the difference in fiber density of homonym regions in the right and left hemisphere. Differences in connectivity patterns between OP2 and PIC were also estimated.

We found that the bilateral intraparietal sulcus, PIC, and to a lesser degree OP2, are key ‘hub’ regions within the multimodal vestibular network. PIC and OP2 structural connectivity patterns were lateralized to the left hemisphere, while structural connectivity patterns of the posterior peri-sylvian supramarginal and superior temporal gyri were lateralized to the right hemisphere. These lateralization patterns were independent of handedness.

We also found that the structural connectivity pattern of PIC is consistent with a key role of PIC in visuo-vestibular processing and that the structural connectivity pattern of OP2 is consistent with integration of mainly vestibular somato-sensory and motor information. These results suggest an analogy between PIC and the simian visual posterior sylvian (VPS) area and OP2 and the simian parieto-insular vestibular cortex (PIVC).

Overall, these findings may provide novel insights to the current models of vestibular function, as well as to the understanding of the complexity and lateralized signs of vestibular syndromes.

Hippocampal formation volume, its subregions, and its specific contributions to visuospatial memory tasks

Visuospatial memory (VSM) is the ability to represent and manipulate visual and spatial information. This cognitive function depends on the functioning of the hippocampal formation (HF), located in the medial portion of the temporal cortex. The present study aimed to investigate whether there is an association between the volume of the HF and performance in VSM tests. High-resolution structural images (T1) and neuropsychological tests evaluating VSM were performed on 31 healthy individuals. A VSM index was created by grouping 5 variables from 5 tasks (4 from the CANTAB battery and 1 from the Rey-Osterrieth Complex Figure test). Multiple linear regression models using the volumes of HF subregions as independent variables and the VSM index as the dependent variable were conducted to test the hypothesis that memory performance could be predicted by HF volumes. We also conducted analyses to explore the role of covariates that may mediate this relationship, specifically age and intelligence quotient (IQ). We found significant associations between the hippocampal subregions of the left hemisphere and the VSM index (F(7,22)=2.758, P=0.032, R2a=0.298). When IQ was accounted for as a covariate, we also found significant results for the right hemisphere (F(8,21)=2.804, P=0.028, R2a=0.517). We concluded that the bilateral hippocampal formations contributed to performance on VSM tasks. Also, VSM processing is essential for a diverse set of daily activities and may be influenced by demographic variables in healthy subjects.

Concussion History and Neuromechanical Responsiveness Asymmetry

CONTEXT

Detection of subtle changes in brain sensorimotor processes may enable clinicians to identify athletes who would derive the greatest benefit from interventions designed to reduce the risk for future injury and progressive neurologic or musculoskeletal dysfunction.

OBJECTIVE

To develop a generalizable statistical model for identifying athletes who possess subtle alterations in sensorimotor processes that may be due to previous concussion.

DESIGN

Cross-sectional study.

SETTING

Residential Olympic Training Center sports medicine clinic.

PATIENTS OR OTHER PARTICIPANTS

A primary cohort of 35 elite athletes and a secondary cohort of 40 elite athletes who performed identical tests the preceding year.

INTERVENTION(S)

Two upper extremity tests of visual-motor reaction time and 2 tests of whole-body reactive agility were administered. The whole-body tests required lateral or diagonal responses to virtual-reality targets, which provided measures of reaction time, speed, acceleration, and deceleration.

MAIN OUTCOME MEASURE(S)

Sport-related concussion history, which was reported by 54% (n = 19) of the athletes in the primary cohort and 45% (n = 18) of the athletes in the secondary cohort.

RESULTS

Univariable analyses identified 12 strong predictors of sport-related concussion history, which we combined to create a composite metric with maximum predictive value. Composite lateral asymmetry for whole-body reactive movements and persisting effects of previous musculoskeletal injury yielded a logistic regression model with exceptionally good discrimination (area under the curve = 0.845) and calibration (predicted-observed probabilities within 7 subgroups: r = 0.959, P = .001). Application of the derived model to compatible data acquired from another cohort of elite athletes demonstrated very good discrimination (area under the curve = 0.772) and calibration (within 8 subgroups: r = 0.849, P = .008).

CONCLUSIONS

Asymmetry in whole-body reactive movement capabilities may be a manifestation of a subtle abnormality in the functional connectivity of brain networks that might be relevant to previously reported associations between sport-related concussion history and musculoskeletal injury occurrence.

Different EEG brain activity in right and left handers during visually induced self-motion perception

Visually induced self-motion perception (vection) relies on visual-vestibular interaction. Imaging studies using vestibular stimulation have revealed a vestibular thalamo-cortical dominance in the right hemisphere in right handers and the left hemisphere in left handers. We investigated if the behavioural characteristics and neural correlates of vection differ between healthy left and right-handed individuals. 64-channel EEG was recorded while 25 right handers and 25 left handers were exposed to vection-compatible roll motion (coherent motion) and a matched, control condition (incoherent motion). Behavioural characteristics, i.e. vection presence, onset latency, duration and subjective strength, were also recorded. The behavioural characteristics of vection did not differ between left and right handers (all p > 0.05). Fast Fourier Transform (FFT) analysis revealed significant decreases in alpha power during vection-compatible roll motion (p < 0.05). The topography of this decrease was handedness-dependent, with left handers showing a left lateralized centro-parietal decrease and right handers showing a bilateral midline centro-parietal decrease. Further time-frequency analysis, time locked to vection onset, revealed a comparable decrease in alpha power around vection onset and a relative increase in alpha power during ongoing vection, for left and right handers. No effects were observed in theta and beta bands. Left and right-handed individuals show vection-related alpha power decreases at different topographical regions, possibly related to the influence of handedness-dependent vestibular dominance in the visual-vestibular interaction that facilitates visual self-motion perception. Despite this difference in where vection-related activity is observed, left and right handers demonstrate comparable perception and underlying alpha band changes during vection.

Direct comparison of activation maps during galvanic vestibular stimulation: A hybrid H2[15 O] PET-BOLD MRI activation study

Previous unimodal PET and fMRI studies in humans revealed a reproducible vestibular brain activation pattern, but with variations in its weighting and expansiveness. Hybrid studies minimizing methodological variations at baseline conditions are rare and still lacking for task-based designs. Thus, we applied for the first time hybrid 3T PET-MRI scanning (Siemens mMR) in healthy volunteers using galvanic vestibular stimulation (GVS) in healthy volunteers in order to directly compare H₂¹⁵O-PET and BOLD MRI responses. List mode PET acquisition started with the injection of 750 MBq H₂¹⁵O simultaneously to MRI EPI sequences. Group-level statistical parametric maps were generated for GVS vs. rest contrasts of PET, MR-onset (event-related), and MR-block. All contrasts showed a similar bilateral vestibular activation pattern with remarkable proximity of activation foci. Both BOLD contrasts gave more bilateral wide-spread activation clusters than PET; no area showed contradictory signal responses. PET still confirmed the right-hemispheric lateralization of the vestibular system, whereas BOLD-onset revealed only a tendency. The reciprocal inhibitory visual-vestibular interaction concept was confirmed by PET signal decreases in primary and secondary visual cortices, and BOLD-block decreases in secondary visual areas. In conclusion, MRI activation maps contained a mixture of CBF measured using H₂¹⁵O-PET and additional non-CBF effects, and the activation-deactivation pattern of the BOLD-block appears to be more similar to the H₂¹⁵O-PET than the BOLD-onset.

Role of diffusion tensor imaging in analyzing the neural connectivity of the parieto-insular vestibular cortex in pusher syndrome: As case report

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.

Changes of brain DTI in healthy human subjects after 520 days isolation and confinement on a simulated mission to Mars

INTRODUCTION

Long-term confinement is known to be a stressful experience with multiple psycho-physiological effects. In the MARS500 project, a real-time simulation of a space-flight to Mars conducted in a hermetically isolated habitat, effects of long-term confinement could be investigated in a unique manner. The aim of this study was to evaluate effects of long-term-confinement on brain cytoarchitecture.

MATERIAL & METHODS

The participants of the MARS500 project underwent 3T-MR imaging including a dedicated DTI-sequence before the isolation, right after ending of confinement and 6 months after the experiment. Voxelwise statistical analysis of the DTI data was carried out using tract-based-spatial statistics, comparing an age-matched control group.

RESULTS

At all three sessions, significant lower fractional anisotropy (FA) than in controls was found in the anterior parts of the callosal body of the participants. Furthermore, after ending of confinement a wide-spread FA reduction could be seen in the right hemisphere culminating in the temporo-parietal-junction-zone. All these areas with decreased FA predominantly showed an elevated radial diffusivity and mean diffusivity while axial diffusivity was less correlated.

DISCUSSION

Long-term confinement does have measurable effects on the microstructure of the brain white matter. We assume effects of sensory deprivation to account for the regional FA reductions seen in the right TPJ. The differences in the Corpus callosum were interpreted as due to preliminary conditions, e.g. personality traits or training effects. FA and radial diffusivity were the predominant DTI parameters with significant changes, suggesting underlying processes of myelin plasticity.

Shift in lateralization during illusory self-motion: EEG responses to visual flicker at 10 Hz and frequency-specific modulation by tACS

Self-motion perception is a key aspect of higher vestibular processing, suggested to rely upon hemispheric lateralization and alpha-band oscillations. The first aim of this study was to test for any lateralization in the EEG alpha band during the illusory sense of self-movement (vection) induced by large optic flow stimuli. Visual stimuli flickered at alpha frequency (approx. 10 Hz) in order to produce steady state visually evoked potentials (SSVEPs), a robust EEG measure which allows probing the frequency-specific response of the cortex. The first main result was that differential lateralization of the alpha SSVEP response was found during vection compared with a matched random motion control condition, supporting the idea of lateralization of visual-vestibular function. Additionally, this effect was frequency-specific, not evident with lower frequency SSVEPs. The second aim of this study was to test for a causal role of the right hemisphere in producing this lateralization effect and to explore the possibility of selectively modulating the SSVEP response. Transcranial alternating current stimulation (tACS) was applied over the right hemisphere simultaneously with SSVEP recording, using a novel artefact removal strategy for combined tACS-EEG. The second main result was that tACS enhanced SSVEP amplitudes, and the effect of tACS was not confined to the right hemisphere. Subsequent control experiments showed the effect of tACS requires the flicker frequency and tACS frequency to be closely matched and tACS to be of sufficient intensity. Combined tACS-SSVEPs are a promising method for future investigation into the role of neural oscillations and for optimizing tACS.

Effects of stimulus conditions on vestibular evoked myogenic potentials in healthy subjects

BACKGROUND

Characteristics of vestibular evoked myogenic potentials (VEMPs) depend on stimulus conditions.

OBJECTIVE

To determine the optimal stimulus conditions for cervical and ocular VEMPs.

METHODS

Participants were 23 healthy subjects. We compared air-conducted cervical and ocular VEMPs elicited by various tone-burst conditions (frequencies 500-1,000 Hz, rise/fall times 1-2 ms, and plateau times 0-6 ms) with an intensity of 105 dB normal hearing level. Effects of simultaneous contralateral masking noise on VEMPs were also evaluated.

RESULTS

The largest cervical VEMP amplitudes were elicited by 500-750 Hz and 2-6 ms plateau time-tone-bursts, and the largest ocular VEMP amplitudes by 750 Hz and 2-4 ms plateau time-tone-bursts. Repeatability of the latency was better at 1 ms than at 2 ms rise/fall time in both VEMPs. In both VEMPs, masking noise reduced amplitude, and in ocular VEMP, amplitudes were significantly larger at the left ear stimulation than the right.

CONCLUSION

Optimal tone-burst stimulation for both VEMPs seemed to be 500-750 Hz frequency and 1/2/1 ms rise/plateau/fall time without contralateral masking noise. Ocular VEMP amplitudes from left ear stimulation were originally larger than those from right ear stimulation.

Auditory Feedback for Navigation with Echoes in Virtual Environments: Training Procedure and Orientation Strategies

Being able to hear objects in an environment, for example using echolocation, is a challenging task. The main goal of the current work is to use virtual environments (VEs) to train novice users to navigate using echolocation. Previous studies have shown that musicians are able to differentiate sound pulses from reflections. This paper presents design patterns for VE simulators for both training and testing procedures, while classifying users' navigation strategies in the VE. Moreover, the paper presents features that increase users' performance in VEs. We report the findings of two user studies: a pilot test that helped improve the sonic interaction design, and a primary study exposing participants to a spatial orientation task during four conditions which were early reflections (RF), late reverberation (RV), early reflections-reverberation (RR) and visual stimuli (V). The latter study allowed us to identify navigation strategies among the users. Some users (10/26) reported an ability to create spatial cognitive maps during the test with auditory echoes, which may explain why this group performed better than the remaining participants in the RR condition.

Optogenetic fMRI interrogation of brain-wide central vestibular pathways

The vestibular system provides a critical role to coordinate balance and movement, yet it remains an underappreciated sense. Functional MRI (fMRI) reveals much information about brain-wide sensory and cognitive processes. However, fMRI mapping of regions that actively process vestibular information remains technically challenging, as it can permit only limited movement during scanning. Here, we deploy fMRI and optogenetic stimulation of vestibular excitatory neurons to visualize numerous brain-wide central vestibular pathways and interrogate their functional roles in multisensory processing. Our study highlights multiple routes to investigate vestibular functions and their integration with other sensory systems. We reveal a method to gain critical knowledge into this critical brain system.

Blood oxygen level-dependent functional MRI (fMRI) constitutes a powerful neuroimaging technology to map brain-wide functions in response to specific sensory or cognitive tasks. However, fMRI mapping of the vestibular system, which is pivotal for our sense of balance, poses significant challenges. Physical constraints limit a subject’s ability to perform motion- and balance-related tasks inside the scanner, and current stimulation techniques within the scanner are nonspecific to delineate complex vestibular nucleus (VN) pathways. Using fMRI, we examined brain-wide neural activity patterns elicited by optogenetically stimulating excitatory neurons of a major vestibular nucleus, the ipsilateral medial VN (MVN). We demonstrated robust optogenetically evoked fMRI activations bilaterally at sensorimotor cortices and their associated thalamic nuclei (auditory, visual, somatosensory, and motor), high-order cortices (cingulate, retrosplenial, temporal association, and parietal), and hippocampal formations (dentate gyrus, entorhinal cortex, and subiculum). We then examined the modulatory effects of the vestibular system on sensory processing using auditory and visual stimulation in combination with optogenetic excitation of the MVN. We found enhanced responses to sound in the auditory cortex, thalamus, and inferior colliculus ipsilateral to the stimulated MVN. In the visual pathway, we observed enhanced responses to visual stimuli in the ipsilateral visual cortex, thalamus, and contralateral superior colliculus. Taken together, our imaging findings reveal multiple brain-wide central vestibular pathways. We demonstrate large-scale modulatory effects of the vestibular system on sensory processing.

Vestibular Function and Hippocampal Volume in the Baltimore Longitudinal Study of Aging (BLSA)

OBJECTIVE

This study evaluated whether reduced vestibular function in aging adults is associated with lower hippocampal volume.

STUDY DESIGN

Cross-sectional study.

SETTING

Baltimore Longitudinal Study of Aging, a long-running longitudinal cohort study of healthy aging.

PATIENTS

Eligible participants were aged ≥ 60 years and had both vestibular physiological testing and brain magnetic resonance imaging at the same visit.

INTERVENTION

Vestibular function testing consisted of the cervical vestibular-evoked myogenic potential (cVEMP) to assess saccular function, ocular VEMP to assess utricular function, and video head-impulse testing to assess the horizontal semicircular canal vestibulo-ocular reflex.

MAIN OUTCOME MEASURE

Hippocampal volume calculated using diffeomorphometry.

RESULTS

The study sample included 103 participants (range of 35-90 participants in subanalyses) with mean (±SD) age 77.2 years (±8.71). Multivariate linear models including age, intracranial volume, sex, and race showed that 1 μV amplitude increase of cVEMP was associated with an increase of 319.1 mm (p = 0.003) in mean hippocampal volume. We did not observe a significant relationship between ocular VEMP amplitude or vestibulo-ocular reflex gain and mean hippocampal volume.

CONCLUSIONS

Lower cVEMP amplitude (i.e., reduced saccular function) was significantly associated with lower mean hippocampal volume. This is in line with previous work demonstrating a link between saccular function and spatial cognition. Hippocampal atrophy may be a mechanism by which vestibular loss contributes to impaired spatial cognition in older adults. Future work using longitudinal data will be needed to evaluate the causal nature of the association between vestibular loss and hippocampal atrophy.

Distorted own-body representations in patients with dizziness and during caloric vestibular stimulation

There is increasing evidence that vestibular disorders evoke deficits reaching far beyond imbalance, oscillopsia and spatial cognition. Yet, how vestibular disorders affect own-body representations, in particular the perceived body shape and size, has been overlooked. Here, we explored vestibular contributions to own-body representations using two approaches. Study 1 measured the occurrence and severity of distorted own-body representations in 60 patients with dizziness and 60 healthy controls using six items from the Cambridge Depersonalization Scale. 12% of the patients have experienced distorted own-body representations (their hands or feet felt larger or smaller), 37% reported abnormal sense of agency, 35% reported disownership for the body, and 22% reported disembodiment. These proportions were larger in patients than controls. Study 2 aimed at testing whether artificial stimulation of the vestibular apparatus produced comparable distortions of own-body representations in healthy volunteers. We compared the effects of right-warm/left-cold caloric vestibular stimulation (CVS), left-warm/right-cold CVS and sham CVS on internal models of the left and right hands using a pointing task. The perceived length of the dorsum of the hand was increased specifically during left-warm/right-cold CVS, and this effect was found for both hands. Our studies show a vestibular contribution to own-body representations and should help understand the complex symptomatology of patients with dizziness.

Right Hemisphere Cognitive Functions: From Clinical and Anatomic Bases to Brain Mapping During Awake Craniotomy Part I: Clinical and Functional Anatomy

The nondominant hemisphere (usually the right) is responsible for primary cognitive functions such as visuospatial and social cognition. Awake surgery using direct electric stimulation for right cerebral tumor removal remains challenging because of the complexity of the functional anatomy and difficulties in adapting standard bedside tasks to awake surgery conditions. An understanding of semiology and anatomic bases, along with an analysis of the available cognitive tasks for visuospatial and social cognition per operative mapping allow neurosurgeons to better appreciate the functional anatomy of the right hemisphere and its relevance to tumor surgery. In this article, the first of a 2-part review, we discuss the anatomic and functional basis of right hemisphere function. Whereas part II of the review focuses primarily on semiology and surgical management of right-sided tumors under awake conditions, this article provides a comprehensive review of knowledge underpinning awake surgery on the right hemisphere.

Apraxia of gait- or apraxia of postural transitions?

"Apraxia of gait" is not a useful concept and freezing of gait should also not be considered an apraxia. The concept of apraxia may, however, be applied to distortions of postural transitions that can accompany fronto-parietal lesions.