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Hadi Z, Mahmud M, Seemungal BM. Brain Mechanisms Explaining Postural Imbalance in Traumatic Brain Injury: A Systematic Review. Brain Connect 2024; 14:144-177. [PMID: 38343363 DOI: 10.1089/brain.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
Introduction: Persisting imbalance and falls in community-dwelling traumatic brain injury (TBI) survivors are linked to reduced long-term survival. However, a detailed understanding of the impact of TBI upon the brain mechanisms mediating imbalance is lacking. To understand the state of the art concerning the brain mechanisms mediating imbalance in TBI, we performed a systematic review of the literature. Methods: PubMed, Web of Science, and Scopus were searched and peer-reviewed research articles in humans, with any severity of TBI (mild, moderate, severe, or concussion), which linked a postural balance assessment (objective or subjective) with brain imaging (through computed tomography, T1-weighted imaging, functional magnetic resonance imaging [fMRI], resting-state fMRI, diffusion tensor imaging, magnetic resonance spectroscopy, single-photon emission computed tomography, electroencephalography, magnetoencephalography, near-infrared spectroscopy, and evoked potentials) were included. Out of 1940 articles, 60 were retrieved and screened, and 25 articles fulfilling inclusion criteria were included. Results: The most consistent finding was the link between imbalance and the cerebellum; however, the regions within the cerebellum were inconsistent. Discussion: The lack of consistent findings could reflect that imbalance in TBI is due to a widespread brain network dysfunction, as opposed to focal cortical damage. The inconsistency in the reported findings may also be attributed to heterogeneity of methodology, including data analytical techniques, small sample sizes, and choice of control groups. Future studies should include a detailed clinical phenotyping of vestibular function in TBI patients to account for the confounding effect of peripheral vestibular disorders on imbalance and brain imaging.
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Affiliation(s)
- Zaeem Hadi
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Mohammad Mahmud
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - Barry M Seemungal
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, United Kingdom
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Park JY, Choi JH, Kwon JH, Weon YC, Lee SM, Kim HJ, Choi SY, Oh EH, Kim HA, Lee H, Kim JS, Choi KD. Incidence, characteristics, and neuroanatomical substrates of vestibular symptoms in supratentorial stroke. J Neurol 2023; 270:2174-2183. [PMID: 36633670 DOI: 10.1007/s00415-023-11566-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
The incidence and characteristics of acute vestibular symptoms, responsible structures, and lateralization of the causative lesions in supratentorial stroke remain unknown. This study aimed to determine the incidence, clinical features, and anatomical correlation of acute vestibular symptoms in supratentorial stroke. We performed a prospective, multicenter, observational study that had recruited patients with supratentorial stroke from the neurology clinics of referral-based four university hospitals in Korea. All patients received a constructed neuro-otological evaluations, and neuroimaging. We analyzed the incidence of acute vestibular symptoms, abnormal ocular motor and vestibular function tests, and stroke lesions. Of 1301 patients with supratentorial stroke, 48 (3.7%) presented with acute vestibular symptoms, and 13 of them (1%) had the vestibular symptoms in isolation. In patients with acute vestibular symptoms, abnormal findings included spontaneous nystagmus (5%), impaired horizontal smooth pursuit (41%), and abnormal tilt of the subjective visual vertical (SVV) (20%). Video head impulse and caloric tests were normal in all the patients. There was no clear correlation between acute vestibular symptoms and involvement of specific vestibular cortex. In patients with unilateral stroke, there was also no lateralization of the causative lesions of acute vestibular symptoms (left vs. right; 52 vs. 48%), even in patients with vertigo (left vs. right; 58 vs. 42%). This study demonstrates that the incidence of acute vestibular symptoms in supratentorial stroke is 3.7%, with being isolated in 1%. The widespread lesions responsible for acute vestibular symptoms implicate diffuse multisensory cortical-subcortical networks in the cerebral hemispheres without a lateralization.
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Affiliation(s)
- Ji-Yun Park
- Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Jae-Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jee-Hyun Kwon
- Department of Neurology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Young Cheol Weon
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Suk-Min Lee
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, College of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea
| | - Hyo Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seo Young Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, College of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea
| | - Eun Hye Oh
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Ah Kim
- Department of Neurology, Keimyung University School of Medicine, 1095, Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea.
| | - Hyung Lee
- Department of Neurology, Keimyung University School of Medicine, 1095, Dalgubeol-Daero, Dalseo-Gu, Daegu, 42601, Republic of Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, College of Medicine, 179, Gudeok-Ro, Seo-Gu, Busan, 602-739, Korea.
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Conrad J, Boegle R, Ruehl RM, Dieterich M. Evaluating the rare cases of cortical vertigo using disconnectome mapping. Brain Struct Funct 2022; 227:3063-3073. [PMID: 35838791 DOI: 10.1007/s00429-022-02530-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/26/2022] [Indexed: 12/26/2022]
Abstract
In rare cases, cortical infarcts lead to vertigo. We evaluated structural and functional disconnection in patients with acute vertigo due to unilateral ischemic cortical infarcts compared to infarcts without vertigo in a similar location with a focus on the connectivity of the vestibular cortex, i.e., the parieto-opercular (retro-)insular cortex (PIVC). Using lesion maps from the ten published case reports, we computed lesion-functional connectivity networks in a set of healthy individuals from the human connectome project. The probability of lesion disconnection was evaluated by white matter disconnectome mapping. In all ten cases with rotational vertigo, disconnections of interhemispheric connections via the corpus callosum were present but were spared in lesions of the PIVC without vertigo. Further, the arcuate fascicle was affected in 90% of the lesions that led to vertigo and spared in lesions that did not lead to vertigo. The lesion-functional connectivity network included vestibulo-cerebellar hubs, the vestibular nuclei, the PIVC, the retro-insular and posterior insular cortex, the multisensory vestibular ventral intraparietal area, motion-sensitive areas (temporal area MT+ and cingulate visual sulcus) as well as hubs for ocular motor control (lateral intraparietal area, cingulate and frontal eye fields). However, this was not sufficient to differentiate between lesions with and without vertigo. Disruption of interhemispheric connections of both PIVC via the corpus callosum and intra-hemispheric disconnection via the arcuate fascicle might be the distinguishing factor between vestibular cortical network lesions that manifest with vertigo compared to those without vertigo.
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Affiliation(s)
- Julian Conrad
- Department of Neurology, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. .,German Center for Vertigo and Balance Disorders (DSGZ), Munich University Hospital, LMU Munich, Munich, Germany.
| | - Rainer Boegle
- Department of Neurology, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Graduate School for Systemic Neuroscience (GSN-LMU), LMU Munich, Munich, Germany
| | - Ria Maxine Ruehl
- Department of Neurology, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Munich University Hospital, LMU Munich, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, Munich University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders (DSGZ), Munich University Hospital, LMU Munich, Munich, Germany.,Graduate School for Systemic Neuroscience (GSN-LMU), LMU Munich, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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