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Lennox-Bowley A, Dasgupta S. Modernising vestibular assessment. J Laryngol Otol 2024; 138:S3-S7. [PMID: 38247298 DOI: 10.1017/s0022215123002128] [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: 01/23/2024]
Abstract
BACKGROUND There is a high prevalence of dizziness, vertigo and balance symptoms in the general population. Symptoms can be generated by many inner-ear vestibular disorders and there are several diagnostic tests available that can help identify the site of the vestibular lesion. There is little consensus on what diagnostic tests are appropriate, with diagnostics either not completed or minimally performed, leading to missed diagnosis, unsatisfactory results for patients and costs to healthcare systems. METHODS This study explored the literature for different neuro-vestibular diagnostic tests not currently considered in the traditional standard vestibular test battery, and examined how they fit effectively into a patient care pathway to help quickly and succinctly identify vestibular function. RESULTS A vestibular patient care pathway is presented for acute and subacute presentation of vestibular disorders. CONCLUSION An accurate diagnosis following a rigorous anamnesis and vestibular testing is paramount for successful management and favourable outcomes.
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Affiliation(s)
- Amy Lennox-Bowley
- Audio-Vestibular Clinic, Hypatia Dizziness and Balance Clinic, Liverpool, UK
| | - Soumit Dasgupta
- Audio-Vestibular Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Hartig J, Nickl V, Vollmuth C, Weiner S, Pham M, Volkmann J, Friedrich MU, Kunze E, Ip CW. Pearls & Oy-sters: INO Plus From Downward Herniation-A Cautionary Tale Regarding Neuro-Ophthalmologic Signatures of Brainstem Compression. Neurology 2024; 102:e209421. [PMID: 38701401 DOI: 10.1212/wnl.0000000000209421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
Pupillary assessment is a quintessential part of the clinical examination in neuro-intensive care patients because it provides insight into the integrity of midbrain reflex arcs. Abnormal pupils, particularly anisocoria and later bilateral fixed mydriasis, are classically used to assess expansive intracranial processes because they are frequently considered early indicators of transtentorial midbrain compression due to elevated intracranial pressure. Complex ocular motor deficits mapping to the midbrain are rarely described in the setting of high transtentorial pressure. This is likely because ocular motor deficits typically occur in conjunction with decreased consciousness and corticospinal tract dysfunction reflecting advanced midbrain compromise. We present a case of left midbrain compression due to downward herniation in a patient with acute-on-chronic bilateral subdural hematoma. Ocular motor assessment demonstrated left internuclear ophthalmoplegia (INO) and an ocular tilt reaction, termed INO plus. However, pupillary, mental status, and sensorimotor examinations were unremarkable. Head magnetic resonance imaging revealed acute perforator ischemia in the left pontomesencephalic tegmentum, localizing to the ipsilateral medial longitudinal fasciculus and graviceptive oculocephalic circuits. Microvascular compromise secondary to mechanical pressure is discussed as a causative mechanism. We caution against overreliance on "telltale pupils" in suspected brainstem compression and recommend checking for other oculomotor signs.
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Affiliation(s)
- Johannes Hartig
- From the Department of Neurology (J.H., C.V., J.V., M.U.F., C.W.I.); Department of Neurosurgery (V.N., E.K.); Department of Neuroradiology (S.W., M.P.), University Hospital Wuerzburg, Germany; and Center for Brain Circuit Therapeutics (M.U.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Vera Nickl
- From the Department of Neurology (J.H., C.V., J.V., M.U.F., C.W.I.); Department of Neurosurgery (V.N., E.K.); Department of Neuroradiology (S.W., M.P.), University Hospital Wuerzburg, Germany; and Center for Brain Circuit Therapeutics (M.U.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christoph Vollmuth
- From the Department of Neurology (J.H., C.V., J.V., M.U.F., C.W.I.); Department of Neurosurgery (V.N., E.K.); Department of Neuroradiology (S.W., M.P.), University Hospital Wuerzburg, Germany; and Center for Brain Circuit Therapeutics (M.U.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Simon Weiner
- From the Department of Neurology (J.H., C.V., J.V., M.U.F., C.W.I.); Department of Neurosurgery (V.N., E.K.); Department of Neuroradiology (S.W., M.P.), University Hospital Wuerzburg, Germany; and Center for Brain Circuit Therapeutics (M.U.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Mirko Pham
- From the Department of Neurology (J.H., C.V., J.V., M.U.F., C.W.I.); Department of Neurosurgery (V.N., E.K.); Department of Neuroradiology (S.W., M.P.), University Hospital Wuerzburg, Germany; and Center for Brain Circuit Therapeutics (M.U.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jens Volkmann
- From the Department of Neurology (J.H., C.V., J.V., M.U.F., C.W.I.); Department of Neurosurgery (V.N., E.K.); Department of Neuroradiology (S.W., M.P.), University Hospital Wuerzburg, Germany; and Center for Brain Circuit Therapeutics (M.U.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Maximilian U Friedrich
- From the Department of Neurology (J.H., C.V., J.V., M.U.F., C.W.I.); Department of Neurosurgery (V.N., E.K.); Department of Neuroradiology (S.W., M.P.), University Hospital Wuerzburg, Germany; and Center for Brain Circuit Therapeutics (M.U.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ekkehard Kunze
- From the Department of Neurology (J.H., C.V., J.V., M.U.F., C.W.I.); Department of Neurosurgery (V.N., E.K.); Department of Neuroradiology (S.W., M.P.), University Hospital Wuerzburg, Germany; and Center for Brain Circuit Therapeutics (M.U.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Chi Wang Ip
- From the Department of Neurology (J.H., C.V., J.V., M.U.F., C.W.I.); Department of Neurosurgery (V.N., E.K.); Department of Neuroradiology (S.W., M.P.), University Hospital Wuerzburg, Germany; and Center for Brain Circuit Therapeutics (M.U.F.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Khazali MF, Daddaoua N, Thier P. Nonhuman primates exploit the prior assumption that the visual world is vertical. J Neurophysiol 2023; 130:1252-1264. [PMID: 37823212 DOI: 10.1152/jn.00514.2022] [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: 12/21/2022] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 10/13/2023] Open
Abstract
When human subjects tilt their heads in dark surroundings, the noisiness of vestibular information impedes precise reports on objects' orientation with respect to Earth's vertical axis. This difficulty is mitigated if a vertical visual background is available. Tilted visual backgrounds induce feelings of head tilt in subjects who are in fact upright. This is often explained as a result of the brain resorting to the prior assumption that natural visual backgrounds are vertical. Here, we tested whether monkeys show comparable perceptual mechanisms. To this end we trained two monkeys to align a visual arrow to a vertical reference line that had variable luminance across trials, while including a large, clearly visible background square whose orientation changed from trial to trial. On ∼20% of all trials, the vertical reference line was left out to measure the subjective visual vertical (SVV). When the frame was upright, the monkeys' SVV was aligned with the gravitational vertical. In accordance with the perceptual reports of humans, however, when the frame was tilted it induced an illusion of head tilt as indicated by a bias in SVV toward the frame orientation. Thus all primates exploit the prior assumption that the visual world is vertical.NEW & NOTEWORTHY Here we show that the principles that characterize the human perception of the vertical are shared by another old world primate species, the rhesus monkey, suggesting phylogenetic continuity. In both species the integration of visual and vestibular information on the orientation of the head relative to the world is similarly constrained by the prior assumption that the visual world is vertical in the sense of having an orientation that is congruent with the gravity vector.
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Affiliation(s)
- Mohammad Farhan Khazali
- Epilepsy Center, Medical Center, University of Freiburg, Freiburg, Germany
- Center for Neural Science, New York University, New York, United States
| | - Nabil Daddaoua
- National Institute on Drug Abuse (NIDA) Intramural Research Program, Baltimore, Maryland, United States
| | - Peter Thier
- Hertie-Institute for Clinical Brain Research, Cognitive Neurology Laboratory, University of Tübingen, Tübingen, Germany
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Grove CR, Klatt BN, Wagner AR, Anson ER. Vestibular perceptual testing from lab to clinic: a review. Front Neurol 2023; 14:1265889. [PMID: 37859653 PMCID: PMC10583719 DOI: 10.3389/fneur.2023.1265889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
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.
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Affiliation(s)
- Colin R. Grove
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Physical Therapy, Department of Physical Medicine and Rehabilitation School of Medicine, Emory University, Atlanta, GA, United States
| | - Brooke N. Klatt
- Physical Therapy Department, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew R. Wagner
- Department of Otolaryngology—Head and Neck Surgery, Ohio State University Wexner Medical Center, Columbus, OH, United States
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH, United States
| | - Eric R. Anson
- Department of Otolaryngology, University of Rochester, Rochester, NY, United States
- Physical Therapy Department, University of Rochester, Rochester, NY, United States
- Department of Neuroscience, University of Rochester, Rochester, NY, United States
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Emonds AMX, Srinath R, Nielsen KJ, Connor CE. Object representation in a gravitational reference frame. eLife 2023; 12:e81701. [PMID: 37561119 PMCID: PMC10414968 DOI: 10.7554/elife.81701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/19/2023] [Indexed: 08/11/2023] Open
Abstract
When your head tilts laterally, as in sports, reaching, and resting, your eyes counterrotate less than 20%, and thus eye images rotate, over a total range of about 180°. Yet, the world appears stable and vision remains normal. We discovered a neural strategy for rotational stability in anterior inferotemporal cortex (IT), the final stage of object vision in primates. We measured object orientation tuning of IT neurons in macaque monkeys tilted +25 and -25° laterally, producing ~40° difference in retinal image orientation. Among IT neurons with consistent object orientation tuning, 63% remained stable with respect to gravity across tilts. Gravitational tuning depended on vestibular/somatosensory but also visual cues, consistent with previous evidence that IT processes scene cues for gravity's orientation. In addition to stability across image rotations, an internal gravitational reference frame is important for physical understanding of a world where object position, posture, structure, shape, movement, and behavior interact critically with gravity.
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Affiliation(s)
- Alexandriya MX Emonds
- Department of Biomedical Engineering, Johns Hopkins University School of MedicineBaltimoreUnited States
- Zanvyl Krieger Mind/Brain Institute, Johns Hopkins UniversityBaltimoreUnited States
| | - Ramanujan Srinath
- Zanvyl Krieger Mind/Brain Institute, Johns Hopkins UniversityBaltimoreUnited States
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of MedicineBaltimoreUnited States
| | - Kristina J Nielsen
- Zanvyl Krieger Mind/Brain Institute, Johns Hopkins UniversityBaltimoreUnited States
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of MedicineBaltimoreUnited States
| | - Charles E Connor
- Zanvyl Krieger Mind/Brain Institute, Johns Hopkins UniversityBaltimoreUnited States
- Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of MedicineBaltimoreUnited States
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Yap JA. Upside-down vision: a systematic review of the literature. BMJ Neurol Open 2022; 4:e000337. [PMID: 36101545 PMCID: PMC9461088 DOI: 10.1136/bmjno-2022-000337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background Reversal of vision metamorphopsia (RVM) is a rarely reported disorder characterised by rotation of vision, 180 degrees in the coronal plane. A systematic review and analysis of all available reports of RVM was undertaken to identify the clinical picture, underlying aetiology and proposed pathophysiology and to define anatomical localisation. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and used Scopus, Web of Science, Ovid, Medline, Embase, PubMed and CINAHL databases to search for articles about RVM. The available articles were published from 1974 to 2022. We summarised the evidence, analysed the data and represented anatomical localisation to provide information on the clinical patterns for diagnostics and management. Results Twenty-eight articles fulfilled the selection criteria, providing 52 cases of reported RVM. Reports focused on the clinical picture and evaluation of neurological signs and symptoms. The most common underlying aetiology was a posterior circulation stroke or interruption of the vestibular system. In the analysis, we demonstrated statistically significant differences between ischaemic and vestibular aetiology in the duration of episodes (p=0.03, Z=2.13) and vomiting (p=0.02, Z=2.28) subgroups. Insults present on brain imaging have been mapped via two-dimensional graphical representations (n=16). Conclusions This review intends to raise awareness of this unusual phenomenon. Swift recognition of this disorder is paramount and appropriate management should be tailored to the individual aetiology. Brain mapping and analysis of cases may elucidate the anatomical localisation of the central integrator of visuospatial orientation. We suggest that sensory information may be synthesised by a multinucleated visuospatial system to form a visual representation of extrapersonal verticality.
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Affiliation(s)
- Joshua Anthony Yap
- Research, Gold Coast University College of Griffith University, Southport, Queensland, Australia
- Neurology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
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Stefano LHS, Favoretto DB, Nascimento DC, Santos LRA, Louzada F, Bikson M, Leite JP, Pontes-Neto OM, Edwards DJ, Edwards TGS. Middle cerebral artery blood flow stability in response to high-definition transcranial electrical stimulation: a randomized sham-controlled clinical trial. Clin Neurol Neurosurg 2022; 220:107345. [DOI: 10.1016/j.clineuro.2022.107345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 11/28/2022]
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Tohyama T, Kondo K, Otaka Y. Effects of Galvanic Vestibular Stimulation on Visual Verticality and Standing Posture Differ Based on the Polarity of the Stimulation and Hemispheric Lesion Side in Patients With Stroke. Front Neurol 2021; 12:768663. [PMID: 34858316 PMCID: PMC8631773 DOI: 10.3389/fneur.2021.768663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/08/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction: There is growing evidence supporting the relationship of vertical misperception and poor balance control with asymmetrical standing posture in patients with stroke. Although the vestibular system has been shown to be responsible for vertical misperception and balance disorders, the effect of galvanic vestibular stimulation (GVS) on both vertical misperception and postural asymmetry after stroke remains elusive. The aim of this study was to investigate the effects of GVS on visual verticality and postural asymmetry after stroke and to clarify whether the effects differ depending on the polarity of the stimulation and hemispheric lesion side. Methods: We measured the subjective visual vertical (SVV) and body weight distribution on each foot in an upright stance in 24 patients with a hemispheric stroke (10 with a left hemisphere lesion and 14 with a right hemisphere lesion) and nine age-matched healthy controls. During the measurements, bipolar GVS (1.5 mA) was applied over the bilateral mastoid processes in three stimulation conditions: contralesional-anodal and ipsilesional-cathodal vestibular stimulation, ipsilesional-anodal and contralesional-cathodal vestibular stimulation, and no stimulation. To examine whether GVS modulates visual verticality and standing posture, SVV and weight-bearing in the three conditions were analyzed. Results: During no stimulation, the SVV deviated to the contralesional side in patients with a right hemisphere lesion, while more weight-bearing was observed on the ipsilesional limb than on the contralesional limb in both patient groups than in the controls. The SVV was modulated by reversing the polarity of GVS in all the groups when the cathodal stimulus side was either ipsilateral or contralateral to the lesion while the ipsilesional-cathodal vestibular stimulation reduced weight-bearing asymmetry in only the patients with a right hemisphere lesion. Conclusions: These findings demonstrate that the effects of GVS on the SVV and standing posture differ depending on the polarity of GVS and the hemispheric lesion side. Patients with a right hemisphere lesion have difficulty maintaining their preferred standing posture under visual verticality modulation evoked by GVS. The application of GVS may clarify whether the vestibular system has neural redundancy after stroke to suppress any effects of the stimulation, including modulation of the visual verticality, on balance.
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Affiliation(s)
- Takamichi Tohyama
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Japan.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kunitsugu Kondo
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Japan
| | - Yohei Otaka
- Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Japan.,Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan
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Brugger F, Walch J, Hägele-Link S, Abela E, Galovic M, Kägi G. Decreased grey matter in the postural control network is associated with lateral flexion of the trunk in Parkinson's disease. Neuroimage Clin 2021; 28:102469. [PMID: 33395964 PMCID: PMC7645287 DOI: 10.1016/j.nicl.2020.102469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/12/2020] [Accepted: 10/11/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Disruption of central networks, particularly of those responsible for integrating multimodal afferents in a spatial reference frame, were proposed in the pathophysiology of lateral trunk flexion in Parkinson's disease (PD). Knowledge about the underlying neuroanatomical structures is limited. OBJECTIVE To investigate if decreased focal grey matter (GM) is associated with trunk flexion to the side and if the revealed GM clusters correlate with a disturbed perception of verticality in PD. METHODS 37 PD patients with and without lateral trunk flexion were recruited. Standardized photos were taken from each patient and trunk orientation was measured by a blinded rater. Voxel-based morphometry (VBM) was used to detect associated clusters of decreased GM. The subjective visual vertical (SVV) was assessed as a marker for perception of verticality and SVV estimates were correlated with GM clusters. RESULTS VBM revealed clusters of decreased GM in the right posterior parietal cortex and in the right thalamus were associated with lateral trunk flexion. The SVV correlated with the extent of trunk flexion, and the side of the SVV tilt correlated with the side of trunk flexion. GM values from the thalamus correlated with the SVV estimates. CONCLUSIONS We report an association between neurodegenerative changes within the posterior parietal cortex and the thalamus and lateral trunk flexion in PD. These brain structures are part of a network proposed to be engaged in postural control and spatial self-perception. Disturbed perception of verticality points to a shifted egocentric spatial reference as an important pathophysiological feature.
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Affiliation(s)
- Florian Brugger
- Department of Neurology, Kantonsspital St. Gallen, Rorschacherstrasse 95, St. Gallen, Switzerland.
| | - Julia Walch
- Department of Neurology, Kantonsspital St. Gallen, Rorschacherstrasse 95, St. Gallen, Switzerland
| | - Stefan Hägele-Link
- Department of Neurology, Kantonsspital St. Gallen, Rorschacherstrasse 95, St. Gallen, Switzerland
| | - Eugenio Abela
- Division of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Marian Galovic
- Department of Neurology, Kantonsspital St. Gallen, Rorschacherstrasse 95, St. Gallen, Switzerland; Clinical and Experimental Epilepsy, Institute of Neurology, University College of London, United Kingdom
| | - Georg Kägi
- Department of Neurology, Kantonsspital St. Gallen, Rorschacherstrasse 95, St. Gallen, Switzerland
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Zabaneh SI, Voss LJ, Szczepek AJ, Olze H, Stölzel K. Methods for Testing the Subjective Visual Vertical during the Chronic Phase of Menière's Disease. Diagnostics (Basel) 2021; 11:diagnostics11020249. [PMID: 33562708 PMCID: PMC7915072 DOI: 10.3390/diagnostics11020249] [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: 01/11/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/25/2022] Open
Abstract
The subjective visual vertical (SVV) evaluates the function of the utricle, which, in patients with Menière’s disease (MD), can be affected by endolymphatic hydrops. This study aimed to determine the SVV in MD patients during the chronic phase of illness compared to healthy participants. The second aim was to compare the SVV measurement tools: the analog bucket test, digital bucket test, and C-SVV© goggles. The SVV scores differed significantly between MD patients and the control group for the analog bucket test (p < 0.001) and the C-SVV® goggles (p = 0.028), but no significance was shown when using the digital bucket test (p = 0.062). When comparing the analog bucket test and the C-SVV® goggles applying the calculated threshold (1.125° in analog bucket test, 2.5° in C-SVV® goggles), the bucket test showed higher accuracy (bucket test 73.84%, C-SVV® goggles 69.23%). When examining the influence of betahistine on SVV scores, there were no statistically significant differences in both the analog bucket test and C-SVV© goggles. We conclude that SVV test can be used as an additional tool to evaluate utricle function during the chronic phase of MD and that the analog bucket test produces the most reliable results. The intake of betahistine does not influence the perception of SVV.
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Affiliation(s)
- Samira Ira Zabaneh
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
| | - Linda Josephine Voss
- Department of Audiology and Phoniatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany;
| | - Agnieszka J. Szczepek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
| | - Heidi Olze
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
| | - Katharina Stölzel
- Department of Otorhinolaryngology, Head and Neck Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität, Berlin Humboldt Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte, Chariteplatz 1, 10117 Berlin, Germany; (S.I.Z.); (A.J.S.); (H.O.)
- Correspondence:
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The Bucket Test Improves Detection of Stroke in Patients With Acute Dizziness. J Emerg Med 2020; 60:485-494. [PMID: 33308916 DOI: 10.1016/j.jemermed.2020.10.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 10/17/2020] [Accepted: 10/22/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND It is challenging to detect posterior circulation strokes in patients presenting to the emergency department (ED) with acute dizziness. The current approach uses a combinatorial head-impulse, nystagmus, and test-of-skew method and is sensitive enough to differentiate central causes from peripheral ones. However, it is difficult to perform and underused. Further, magnetic resonance imaging (MRI) of the brain is not always available and can have low sensitivity for detecting posterior circulation strokes. OBJECTIVES We evaluated the feasibility and utility of the bucket test (BT), which measures the difference between patient's subjective perception of the visual vertical and the true vertical, as a screening tool for stroke in patients presenting to the ED with acute dizziness. METHODS In this work, we prospectively enrolled 81 patients that presented to our academic medical center ED with dizziness as their chief complaint. The BT was performed 3 times for every patient. RESULTS Seventy-one patients met the study criteria and were included in the analysis. Ten patients were excluded because of a history of drug-seeking behavior. There were no reported difficulties performing the BT. Six patients (8%) were diagnosed with ischemic stroke on MRI and 1 additional patient was diagnosed with transient ischemic attack and found to have a stroke on subsequent MRI. All 7 patients with dizziness attributed to cerebrovascular etiology had an abnormal BT, resulting in a sensitivity of 100% (95% confidence interval [CI] 59-100%). The specificity of the BT was 38% (95% CI 24-52%). The positive predictive value of the BT for detecting stroke was 18% (95% CI 15-21%). CONCLUSIONS The BT is an easy, cheap, safe, and quick test that is feasible and sensitive to screen acutely dizzy patients for stroke in the ED.
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Time Course of Sensory Substitution for Gravity Sensing in Visual Vertical Orientation Perception following Complete Vestibular Loss. eNeuro 2020; 7:ENEURO.0021-20.2020. [PMID: 32561572 PMCID: PMC7358335 DOI: 10.1523/eneuro.0021-20.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 01/06/2023] Open
Abstract
Loss of vestibular function causes severe acute symptoms of dizziness and disorientation, yet the brain can adapt and regain near to normal locomotor and orientation function through sensory substitution. Animal studies quantifying functional recovery have yet been limited to reflexive eye movements. Here, we studied the interplay between vestibular and proprioceptive graviception in macaque monkeys trained in an earth-vertical visual orientation (subjective visual vertical; SVV) task and measured the time course of sensory substitution for gravity perception following complete bilateral vestibular loss (BVL). Graviceptive gain, defined as the ratio of perceived versus actual tilt angle, decreased to 20% immediately following labyrinthectomy, and recovered to nearly prelesion levels with a time constant of approximately three weeks of postsurgery testing. We conclude that proprioception accounts for up to 20% of gravity sensing in normal animals, and is re-weighted to substitute completely perceptual graviception after vestibular loss. We show that these results can be accounted for by an optimal sensory fusion model.
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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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Mori K, Nakamura K, Hashimoto S, Wakida M, Hase K. Novel characterization of subjective visual vertical in patients with unilateral spatial neglect. Neurosci Res 2020; 163:18-25. [PMID: 32084447 DOI: 10.1016/j.neures.2020.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 01/24/2020] [Accepted: 02/18/2020] [Indexed: 10/25/2022]
Abstract
Visual vertical (VV), visually perceived direction of gravity, is widely measured to assess the vestibular function and visuospatial cognition. VV has been assessed by comparing orientation and variability of measured values separately between subject groups. However, changes in orientation and variability often differ in patients with unilateral spatial neglect (USN). Here, we developed a novel classification of VV that combines orientation and variability and characterized the effects of USN on VV. Forty-three subacute stroke patients with or without USN (USN+, n = 17; USN-, n = 26) and 33 age-matched controls were included in the study. In darkness, a luminous line, initially tilted at 30° either to the left or right, gradually rotated towards the vertical. The VV was defined as the deviation of the subjectively-perceived vertical from the true vertical. The new classification demonstrated that, while the majority of USN + patients (14/17) exhibited large variability, nine showed normal orientation and five showed greater contra-lesional deviation of orientation, suggesting different underlying mechanisms for orientation and variability. Further analyses revealed VV deviation to the initial tilt in all groups. However, the deviation in USN + was larger and more variable, indicating attentional disorders. Such characterization would contribute to individually specified clinical rehabilitation.
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Affiliation(s)
- Kimihiko Mori
- Department of Physical Medicine and Rehabilitation, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan; Department of Physiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan.
| | - Kae Nakamura
- Department of Physiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
| | - Shingo Hashimoto
- Department of Physical Medicine and Rehabilitation, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan
| | - Masanori Wakida
- Department of Physical Medicine and Rehabilitation, Kansai Medical University Kori Hospital, 8-45 Korihondoricho, Neyagawa, Osaka 572-8551, Japan
| | - Kimitaka Hase
- Department of Physical Medicine and Rehabilitation, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka 573-1010, Japan
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Santos TEG, Baggio JAO, Rondinoni C, Machado L, Weber KT, Stefano LH, Santos AC, Pontes-Neto OM, Leite JP, Edwards DJ. Fractional Anisotropy of Thalamic Nuclei Is Associated With Verticality Misperception After Extra-Thalamic Stroke. Front Neurol 2019; 10:697. [PMID: 31379702 PMCID: PMC6650785 DOI: 10.3389/fneur.2019.00697] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 06/14/2019] [Indexed: 12/31/2022] Open
Abstract
Verticality misperception after stroke is a frequent neurological deficit that leads to postural imbalance and a higher risk of falls. The posterior thalamic nuclei are described to be involved with verticality perception, but it is unknown if extra-thalamic lesions can have the same effect via diaschisis and degeneration of thalamic nuclei. We investigated the relationship between thalamic fractional anisotropy (FA, a proxy of structural integrity), and verticality perception, in patients after stroke with diverse encephalic extra-thalamic lesions. We included 11 first time post-stroke patients with extra-thalamic primary lesions, and compared their region-based FA to a group of 25 age-matched healthy controls. For the patient sample, correlation and regression analyses evaluated the relationship between thalamic nuclei FA and error of postural vertical (PV) and haptic vertical (HV) in the roll (PVroll/HVroll) and pitch planes (PVpitch/HVpitch). Relative to controls, patients showed decreased FA of anterior, ventral anterior, ventral posterior lateral, dorsal, and pulvinar thalamic nuclei, despite the primary lesions being extra-thalamic. We found a significant correlation between HVroll, and FA in the anterior and dorsal nuclei, and PVroll with FA in the anterior nucleus. FA in the anterior, ventral anterior, ventral posterior lateral, dorsal and pulvinar nuclei predicted PV, and FA in the ventral anterior, ventral posterior lateral and dorsal nuclei predicted HV. While prior studies indicate that primary lesions of the thalamus can result in verticality misperception, here we present evidence supporting that secondary degeneration of thalamic nuclei via diaschisis can also be associated with verticality misperception after stroke.
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Affiliation(s)
- Taiza E. G. Santos
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Jussara A. O. Baggio
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Carlo Rondinoni
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Laura Machado
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Karina T. Weber
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Luiz H. Stefano
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Antonio C. Santos
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Octavio M. Pontes-Neto
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Joao P. Leite
- Department of Neurosciences and Behavioral Sciences, Ribeirao Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Dylan J. Edwards
- Moss Rehabilitation Research Institute, Elkins Park, PA, United States
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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Dieterich M, Brandt T. Perception of Verticality and Vestibular Disorders of Balance and Falls. Front Neurol 2019; 10:172. [PMID: 31001184 PMCID: PMC6457206 DOI: 10.3389/fneur.2019.00172] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/08/2019] [Indexed: 11/16/2022] Open
Abstract
Objective: To review current knowledge of the perception of verticality, its normal function and disorders. This is based on an integrative graviceptive input from the vertical semicircular canals and the otolith organs. Methods: The special focus is on human psychophysics, neurophysiological and imaging data on the adjustments of subjective visual vertical (SVV) and the subjective postural vertical. Furthermore, examples of mathematical modeling of specific vestibular cell functions for orientation in space in rodents and in patients are briefly presented. Results: Pathological tilts of the SVV in the roll plane are most sensitive and frequent clinical vestibular signs of unilateral lesions extending from the labyrinths via the brainstem and thalamus to the parieto-insular vestibular cortex. Due to crossings of ascending graviceptive fibers, peripheral vestibular and pontomedullary lesions cause ipsilateral tilts of the SVV; ponto-mesencephalic lesions cause contralateral tilts. In contrast, SVV tilts, which are measured in unilateral vestibular lesions at thalamic and cortical levels, have two different characteristic features: (i) they may be ipsi- or contralateral, and (ii) they are smaller than those found in lower brainstem or peripheral lesions. Motor signs such as head tilt and body lateropulsion, components of ocular tilt reaction, are typical for vestibular lesions of the peripheral vestibular organ and the pontomedullary brainstem (vestibular nucleus). They are less frequent in midbrain lesions (interstitial nucleus of Cajal) and rare in cortical lesions. Isolated body lateropulsion is chiefly found in caudal lateral medullary brainstem lesions. Vestibular function in the roll plane and its disorders can be mathematically modeled by an attractor model of angular head velocity cell and head direction cell function. Disorders manifesting with misperception of the body vertical are the pusher syndrome, the progressive supranuclear palsy, or the normal pressure hydrocephalus; they may affect roll and/or pitch plane. Conclusion: Clinical determinations of the SVV are easy and reliable. They indicate acute unilateral vestibular dysfunctions, the causative lesion of which extends from labyrinth to cortex. They allow precise topographical diagnosis of side and level in unilateral brainstem or peripheral vestibular disorders. SVV tilts may coincide with or differ from the perception of body vertical, e.g., in isolated body lateropulsion.
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Affiliation(s)
- Marianne Dieterich
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University, Munich, Germany.,Department of Neurology, Ludwig-Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University, Munich, Germany.,Clinical Neuroscience, Ludwig-Maximilians University, Munich, Germany
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17
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Egocentric processing in the roll plane and dorsal parietal cortex: A TMS-ERP study of the subjective visual vertical. Neuropsychologia 2019; 127:113-122. [DOI: 10.1016/j.neuropsychologia.2019.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/29/2019] [Accepted: 02/28/2019] [Indexed: 11/18/2022]
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18
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Glasauer S, Dieterich M, Brandt T. Neuronal network-based mathematical modeling of perceived verticality in acute unilateral vestibular lesions: from nerve to thalamus and cortex. J Neurol 2018; 265:101-112. [PMID: 29845378 DOI: 10.1007/s00415-018-8909-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
Acute unilateral lesions of vestibular graviceptive pathways from the otolith organs and semicircular canals via vestibular nuclei and the thalamus to the parieto-insular vestibular cortex regularly cause deviations of perceived verticality in the frontal roll plane. These tilts are ipsilateral in peripheral and in ponto-medullary lesions and contralateral in ponto-mesencephalic lesions. Unilateral lesions of the vestibular thalamus or cortex cause smaller tilts of the perceived vertical, which may be either ipsilateral or contralateral. Using a neural network model, we previously explained why unilateral vestibular midbrain lesions rarely manifest with rotational vertigo. We here extend this approach, focussing on the direction-specific deviations of perceived verticality in the roll plane caused by acute unilateral vestibular lesions from the labyrinth to the cortex. Traditionally, the effect of unilateral peripheral lesions on perceived verticality has been attributed to a lesion-based bias of the otolith system. We here suggest, on the basis of a comparison of model simulations with patient data, that perceived visual tilt after peripheral lesions is caused by the effect of a torsional semicircular canal bias on the central gravity estimator. We further argue that the change of gravity coding from a peripheral/brainstem vectorial representation in otolith coordinates to a distributed population coding at thalamic and cortical levels can explain why unilateral thalamic and cortical lesions have a variable effect on perceived verticality. Finally, we propose how the population-coding network for gravity direction might implement the elements required for the well-known perceptual underestimation of the subjective visual vertical in tilted body positions.
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Affiliation(s)
- S Glasauer
- Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany. .,German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany.
| | - M Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-University, Munich, Germany.,German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - T Brandt
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany.,Clinical Neuroscience, Ludwig-Maximilians-University, Munich, Germany
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19
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Why acute unilateral vestibular midbrain lesions rarely manifest with rotational vertigo: a clinical and modelling approach to head direction cell function. J Neurol 2018; 265:1184-1198. [PMID: 29549469 PMCID: PMC5937880 DOI: 10.1007/s00415-018-8828-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 12/26/2022]
Abstract
A retrospective clinical study focused on the frequency of rotational vertigo in 63 patients with acute unilateral midbrain strokes involving the vestibular and ocular motor systems. In contrast to unilateral pontomedullary brainstem lesions, rotational vertigo in midbrain lesions occurred with a low frequency (14%) and transient (< 1 day) course. Swaying vertigo or unspecific dizziness (22%) and postural imbalance (31%) were more frequent. Midbrain strokes with transient rotational vertigo manifested with lesions chiefly in the caudal midbrain tegmentum, while manifestations with swaying, unspecific, or no vertigo chiefly occurred in rostral mesencephalic or meso-diencephalic lesions. We hypothesize that these different manifestations can be explained by the distribution of two separate cell systems based on semicircular canal function: the angular head-velocity cells and the head direction cells, both of which code for head rotation. Animal experiments have shown that angular head-velocity cells are located mainly in the lower brainstem up to the midbrain, whereas the head direction cells are found from the midbrain and thalamic level up to cortical regions. Due to the differences in coding, unilateral dysfunction of the angular velocity cell system should result in the sensation of rotation, while unilateral dysfunction of the head direction cell system should result in dizziness and unsteadiness. We simulated the different manifestations of vestibular dysfunction using a mathematical neural network model of the head direction cell system. This model predicted and confirmed our clinical findings that unilateral caudal and rostral brainstem lesions have different effects on vestibular function.
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20
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Kim SH, Kim JS. Effects of Head Position on Perception of Gravity in Vestibular Neuritis and Lateral Medullary Infarction. Front Neurol 2018; 9:60. [PMID: 29483891 PMCID: PMC5816270 DOI: 10.3389/fneur.2018.00060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 01/23/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Internal representation of gravity can be quantified by measuring the subjective visual vertical (SVV). Modulation of verticality perception during head tilts may be perturbed in vestibular disorders causing SVV tilts in the upright head position. This study aimed to determine the influence of head tilts on the estimation of SVV in acute vestibular disorders. Methods We measured the SVV in 37 patients with acute vestibular symptoms due to unilateral vestibular neuritis (VN) (n = 28) and lateral medullary infarction (LMI) (n = 9). Measurements of the SVV were performed under head upright, head tilt 30° and 60° in each direction. Seventeen normal subjects served as the control. Results In controls, head tilt of 30° produced a contraversive shift of the SVV (the E-effect), and head tilt of 60° generated an ipsiversive shift (the A-effect). Patients with VN showed only the A-effect irrespective of the direction and amplitude of head tilt. Patients with LMI could estimate earth verticality accurately during head tilts. Patients with VN during the recovery phase showed the patterns of SVV modulation similar to those observed in the controls either with head upright or tilted. Conclusion Given the absence of the E-effect in acute VN, the peripheral otolithic inputs appear to be essential in the perception of earth vertical during small static head tilts.
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Affiliation(s)
- Sung-Hee Kim
- Department of Neurology, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
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21
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Kheradmand A, Winnick A. Perception of Upright: Multisensory Convergence and the Role of Temporo-Parietal Cortex. Front Neurol 2017; 8:552. [PMID: 29118736 PMCID: PMC5660972 DOI: 10.3389/fneur.2017.00552] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/28/2017] [Indexed: 12/18/2022] Open
Abstract
We inherently maintain a stable perception of the world despite frequent changes in the head, eye, and body positions. Such "orientation constancy" is a prerequisite for coherent spatial perception and sensorimotor planning. As a multimodal sensory reference, perception of upright represents neural processes that subserve orientation constancy through integration of sensory information encoding the eye, head, and body positions. Although perception of upright is distinct from perception of body orientation, they share similar neural substrates within the cerebral cortical networks involved in perception of spatial orientation. These cortical networks, mainly within the temporo-parietal junction, are crucial for multisensory processing and integration that generate sensory reference frames for coherent perception of self-position and extrapersonal space transformations. In this review, we focus on these neural mechanisms and discuss (i) neurobehavioral aspects of orientation constancy, (ii) sensory models that address the neurophysiology underlying perception of upright, and (iii) the current evidence for the role of cerebral cortex in perception of upright and orientation constancy, including findings from the neurological disorders that affect cortical function.
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Affiliation(s)
- Amir Kheradmand
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Otolaryngology – Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ariel Winnick
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
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22
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Visual verticality perception after stroke: A systematic review of methodological approaches and suggestions for standardization. Ann Phys Rehabil Med 2017; 60:208-216. [PMID: 27079584 DOI: 10.1016/j.rehab.2016.02.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/03/2016] [Accepted: 02/07/2016] [Indexed: 11/22/2022]
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23
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Brandt T, Dieterich M. The dizzy patient: don't forget disorders of the central vestibular system. Nat Rev Neurol 2017; 13:352-362. [DOI: 10.1038/nrneurol.2017.58] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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24
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Isaac V, Olmedo D, Aboitiz F, Delano PH. Altered Cervical Vestibular-Evoked Myogenic Potential in Children with Attention Deficit and Hyperactivity Disorder. Front Neurol 2017; 8:90. [PMID: 28348547 PMCID: PMC5346589 DOI: 10.3389/fneur.2017.00090] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/24/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Emerging evidence suggests that children with attention deficit and hyperactivity disorder (ADHD) present more difficulties in standing and walking balance than typically developing children. Most of previous studies have assessed these functions using postural and sensory organization tests showing differences in balance performance between control and ADHD children. However, to date, it is unknown whether these balance alterations are accompanied with vestibular dysfunction. The principal aim of this study is to evaluate vestibular otolith function in ADHD and matched control children. METHODS We assessed vestibular otolith function in children with ADHD and controls using the subjective visual vertical (SVV) bucket test and cervical vestibular-evoked myogenic potentials (cVEMPs). In addition, gait and balance were evaluated using the dynamic gait index (DGI) and computerized posturography. RESULTS Non-significant differences between groups were obtained in SVV evaluation. DGI results show lower scores for overall test performance in children with ADHD (p < 0.001), while computerized postural recordings showed significant differences for the limit of stability between groups (p = 0.02). cVEMPs in response to 500 Hz tone bursts presented at 100 dB were absent or reduced in children with ADHD, as revealed by differences in P1 and N1 peak-to-peak amplitudes between groups (p < 0.01). CONCLUSION These findings suggest that vestibular brainstem reflexes are altered in a subset of children with ADHD. We propose to include cVEMP reflexes in the clinical evaluation of ADHD patients.
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Affiliation(s)
- Valeria Isaac
- Otolaryngology Department, Clinical Hospital of the University of Chile, Santiago, Chile; Pediatric Diagnostic and Therapy Center, CERIL, Santiago, Chile
| | - Diego Olmedo
- Otolaryngology Department, Clinical Hospital of the University of Chile , Santiago , Chile
| | - Francisco Aboitiz
- Departamento de Psiquiatría and Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Paul H Delano
- Otolaryngology Department, Clinical Hospital of the University of Chile, Santiago, Chile; Physiology and Biophysics, ICBM, Faculty of Medicine, University of Chile, Santiago, Chile
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25
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Becker-Bense S, Buchholz HG, Baier B, Schreckenberger M, Bartenstein P, Zwergal A, Brandt T, Dieterich M. Functional Plasticity after Unilateral Vestibular Midbrain Infarction in Human Positron Emission Tomography. PLoS One 2016; 11:e0165935. [PMID: 27824897 PMCID: PMC5100888 DOI: 10.1371/journal.pone.0165935] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 10/20/2016] [Indexed: 11/18/2022] Open
Abstract
The aim of the study was to uncover mechanisms of central compensation of vestibular function at brainstem, cerebellar, and cortical levels in patients with acute unilateral midbrain infarctions presenting with an acute vestibular tone imbalance. Eight out of 17 patients with unilateral midbrain infarctions were selected on the basis of signs of a vestibular tone imbalance, e.g., graviceptive (tilts of perceived verticality) and oculomotor dysfunction (skew deviation, ocular torsion) in F18-fluordeoxyglucose (FDG)-PET at two time points: A) in the acute stage, and B) after recovery 6 months later. Lesion-behavior mapping analyses with MRI verified the exact structural lesion sites. Group subtraction analyses and comparisons with healthy controls were performed with Statistic Parametric Mapping for the PET data. A comparison of PET A of acute-stage patients with that of healthy controls showed increases in glucose metabolism in the cerebellum, motion-sensitive visual cortex areas, and inferior temporal lobe, but none in vestibular cortex areas. At the supratentorial level bilateral signal decreases dominated in the thalamus, frontal eye fields, and anterior cingulum. These decreases persisted after clinical recovery in contrast to the increases. The transient activations can be attributed to ocular motor and postural recovery (cerebellum) and sensory substitution of vestibular function for motion perception (visual cortex). The persisting deactivation in the thalamic nuclei and frontal eye fields allows alternative functional interpretations of the thalamic nuclei: either a disconnection of ascending sensory input occurs or there is a functional mismatch between expected and actual vestibular activity. Our data support the view that both thalami operate separately for each hemisphere but receive vestibular input from ipsilateral and contralateral midbrain integration centers. Normally they have gatekeeper functions for multisensory input to the cortex and automatic motor output to subserve balance and locomotion, as well as sensorimotor integration.
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Affiliation(s)
- Sandra Becker-Bense
- Department of Neurology, University of Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders-IFB, University of Munich, Munich, Germany
| | - Hans-Georg Buchholz
- Department of Nuclear Medicine, Johannes Gutenberg-University, Mainz, Germany
| | - Bernhard Baier
- Department of Neurology, Johannes Gutenberg-University, Mainz, Germany
| | | | - Peter Bartenstein
- German Center for Vertigo and Balance Disorders-IFB, University of Munich, Munich, Germany
- Department of Nuclear Medicine, University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), University of Munich, Munich, Germany
| | - Andreas Zwergal
- Department of Neurology, University of Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders-IFB, University of Munich, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders-IFB, University of Munich, Munich, Germany
- Institute for Clinical Neuroscience, University of Munich, Munich, Germany
| | - Marianne Dieterich
- Department of Neurology, University of Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders-IFB, University of Munich, Munich, Germany
- Munich Cluster of Systems Neurology (SyNergy), University of Munich, Munich, Germany
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26
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Maffei V, Mazzarella E, Piras F, Spalletta G, Caltagirone C, Lacquaniti F, Daprati E. Processing of visual gravitational motion in the peri-sylvian cortex: Evidence from brain-damaged patients. Cortex 2016; 78:55-69. [DOI: 10.1016/j.cortex.2016.02.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 01/29/2016] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
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27
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Baier B, Conrad J, Stephan T, Kirsch V, Vogt T, Wilting J, Müller-Forell W, Dieterich M. Vestibular thalamus. Neurology 2015; 86:134-40. [DOI: 10.1212/wnl.0000000000002238] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 09/08/2015] [Indexed: 11/15/2022] Open
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28
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Baier B, Vogt T, Rohde F, Cuvenhaus H, Conrad J, Dieterich M. Deep brain stimulation of the nucleus ventralis intermedius: a thalamic site of graviceptive modulation. Brain Struct Funct 2015; 222:645-650. [PMID: 26650047 DOI: 10.1007/s00429-015-1157-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 11/24/2015] [Indexed: 11/28/2022]
Abstract
Based on animal studies, it has been shown that the nucleus ventralis intermedius (VIM) of the thalamus plays an important role within the vestibular system. A few human studies support the vestibular role of the VIM. In this study, we aimed to test the hypothesis whether changing the stimulation status in patients with unilateral deep brain stimulation in the VIM causally modulates the vestibular system, i.e., the graviceptive vertical perception. We tested six tremor patients for tilt of subjective visual vertical (SVV) with unilateral DBS in the VIM (mean age 67 years; mean time since electrode implantation 55 months). The mean tilt of the patients during the stimulator "on" condition was 1.4° to the contraversive side [standard deviation (SD) ± 0.4°] whereas during the "off" period a mean contraversive tilt of 4.4° (SD ± 3.0°) was obtained (p = 0.02). Thus, we were able to show that otolith-dominated graviceptive vertical perception can be directly modulated by changing the status of DBS VIM stimulation, indicating that the VIM is directly involved in (contraversive) vertical perception and its thalamic pathways.
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Affiliation(s)
- Bernhard Baier
- Department of Neurology, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany. .,Neurology Department, Edith-Stein Fachklinik, Bad Bergzabern, Germany.
| | - Thomas Vogt
- Department of Neurology, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Franziska Rohde
- Department of Neurology, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Hannah Cuvenhaus
- Department of Neurology, Johannes Gutenberg University, Langenbeckstr. 1, 55131, Mainz, Germany.,Neurology Department, Edith-Stein Fachklinik, Bad Bergzabern, Germany
| | - Julian Conrad
- Department of Neurology and IFBLMU, Ludwig-Maximilians-University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Marianne Dieterich
- Department of Neurology and IFBLMU, Ludwig-Maximilians-University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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29
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Piscicelli C, Barra J, Sibille B, Bourdillon C, Guerraz M, Pérennou DA. Maintaining Trunk and Head Upright Optimizes Visual Vertical Measurement After Stroke. Neurorehabil Neural Repair 2015; 30:9-18. [DOI: 10.1177/1545968315583722] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Visual vertical (VV) measurement provides information about spatial cognition and is now part of postural disorders assessment. Guidelines for clinical VV measurement after stroke remain to be established, especially regarding the orientation settings for patients who do not sit upright. Objectives. We analyzed the need to control body orientation while patients estimate the VV. Methods. VV orientation and variability were assessed in 20 controls and 36 subacute patients undergoing rehabilitation after a first hemisphere stroke, in 3 settings: body not maintained (trunk and head free), partially maintained (trunk maintained, head free), or maintained (trunk and head). VV was analyzed as a function of trunk and head tilt, also quantified. Results. Trunk and head orientations were independent. The ability to sit independently was affected by a tilted trunk. The setting had a strong effect on VV orientation and variability in patients with contralesional trunk tilt (n = 11; trunk orientation −18.4 ± 11.7°). The contralesional VV bias was severe and consistent under partially maintained (−8.4 ± 5.2°) and maintained (−7.8 ± 3.5°) settings, whereas various individual behaviors reduced the mean bias under the nonmaintained setting (−3.6 ± 9.3°, P < .05). VV variability was lower under the maintained (1.5 ± 0.2°) than nonmaintained (3.7 ± 0.4°, P < .001) and partially maintained (3.6 ± 0.2°, P < .001) settings. In contrast, setting had no effect in patients with satisfactory postural control in sitting. Conclusion. Subject setting improves VV measurement in stroke patients with postural disorders. Maintaining the trunk upright enhances the validity of VV orientation, and maintaining the head upright enhances the validity of within-subject variability. Measuring VV without any body maintaining is valid in patients with satisfactory balance abilities.
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Affiliation(s)
- Celine Piscicelli
- Grenoble University Hospital, Grenoble, France
- Grenoble-Alpes University, Grenoble, France
| | | | | | | | | | - Dominic Alain Pérennou
- Grenoble University Hospital, Grenoble, France
- Grenoble-Alpes University, Grenoble, France
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30
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Droby A, Fleischer V, Carnini M, Zimmermann H, Siffrin V, Gawehn J, Erb M, Hildebrandt A, Baier B, Zipp F. The impact of isolated lesions on white-matter fiber tracts in multiple sclerosis patients. NEUROIMAGE-CLINICAL 2015; 8:110-6. [PMID: 26106534 PMCID: PMC4473264 DOI: 10.1016/j.nicl.2015.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 03/08/2015] [Indexed: 01/05/2023]
Abstract
Infratentorial lesions have been assigned an equivalent weighting to supratentorial plaques in the new McDonald criteria for diagnosing multiple sclerosis. Moreover, their presence has been shown to have prognostic value for disability. However, their spatial distribution and impact on network damage is not well understood. As a preliminary step in this study, we mapped the overall infratentorial lesion pattern in relapsing-remitting multiple sclerosis patients (N = 317) using MRI, finding the pons (lesion density, 14.25/cm(3)) and peduncles (13.38/cm(3)) to be predilection sites for infratentorial lesions. Based on these results, 118 fiber bundles from 15 healthy controls and a subgroup of 23 patients showing lesions unilaterally at the predilection sites were compared using diffusion tensor imaging to analyze the impact of an isolated infratentorial lesion on the affected fiber tracts. Fractional anisotropy, mean diffusion as well as axial and radial diffusivity were investigated at the lesion site and along the entire fiber tract. Infratentorial lesions were found to have an impact on the fractional anisotropy and radial diffusivity not only at the lesion site itself but also along the entire affected fiber tract. As previously found in animal experiments, inflammatory attack in the posterior fossa in multiple sclerosis impacts the whole affected fiber tract. Here, this damaging effect, reflected by changes in diffusivity measures, was detected in vivo in multiple sclerosis patients in early stages of the disease, thus demonstrating the influence of a focal immune attack on more distant networks, and emphasizing the pathophysiological role of Wallerian degeneration in multiple sclerosis.
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Affiliation(s)
- Amgad Droby
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Neuroimage Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University, Mainz, Germany
| | - Vinzenz Fleischer
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Neuroimage Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University, Mainz, Germany
| | - Marco Carnini
- Department of Computer Science, Johannes Gutenberg University, Mainz, Germany
| | - Hilga Zimmermann
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Neuroimage Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University, Mainz, Germany
| | - Volker Siffrin
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Joachim Gawehn
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Michael Erb
- Department of Biomedical Magnetic Resonance, University Hospital, Tübingen, Germany
| | - Andreas Hildebrandt
- Department of Computer Science, Johannes Gutenberg University, Mainz, Germany
| | - Bernhard Baier
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Neuroimage Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University, Mainz, Germany
| | - Frauke Zipp
- Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Neuroimage Center (NIC) of the Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University, Mainz, Germany
- Corresponding author at: Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Neuroimage Center (NIC) of the Focus Program Translational Neuroscience (FTN), Langenbeckstr. 1, 55131 Mainz, Germany. Tel.: +49 (0)6131 17 7156; fax: +49 (0)6131 17 5697.
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31
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Phillips JO, Ling L, Nie K, Jameyson E, Phillips CM, Nowack AL, Golub JS, Rubinstein JT. Vestibular implantation and longitudinal electrical stimulation of the semicircular canal afferents in human subjects. J Neurophysiol 2015; 113:3866-92. [PMID: 25652917 DOI: 10.1152/jn.00171.2013] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 02/02/2015] [Indexed: 11/22/2022] Open
Abstract
Animal experiments and limited data in humans suggest that electrical stimulation of the vestibular end organs could be used to treat loss of vestibular function. In this paper we demonstrate that canal-specific two-dimensionally (2D) measured eye velocities are elicited from intermittent brief 2 s biphasic pulse electrical stimulation in four human subjects implanted with a vestibular prosthesis. The 2D measured direction of the slow phase eye movements changed with the canal stimulated. Increasing pulse current over a 0-400 μA range typically produced a monotonic increase in slow phase eye velocity. The responses decremented or in some cases fluctuated over time in most implanted canals but could be partially restored by changing the return path of the stimulation current. Implantation of the device in Meniere's patients produced hearing and vestibular loss in the implanted ear. Electrical stimulation was well tolerated, producing no sensation of pain, nausea, or auditory percept with stimulation that elicited robust eye movements. There were changes in slow phase eye velocity with current and over time, and changes in electrically evoked compound action potentials produced by stimulation and recorded with the implanted device. Perceived rotation in subjects was consistent with the slow phase eye movements in direction and scaled with stimulation current in magnitude. These results suggest that electrical stimulation of the vestibular end organ in human subjects provided controlled vestibular inputs over time, but in Meniere's patients this apparently came at the cost of hearing and vestibular function in the implanted ear.
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Affiliation(s)
- James O Phillips
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington; National Primate Research Center, University of Washington, Seattle, Washington; and Virginia Merrill Bloedel Hearing Research Center, University of Washington, Seattle, Washington
| | - Leo Ling
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington; National Primate Research Center, University of Washington, Seattle, Washington; and
| | - Kaibao Nie
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington; Virginia Merrill Bloedel Hearing Research Center, University of Washington, Seattle, Washington
| | - Elyse Jameyson
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington
| | - Christopher M Phillips
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington; National Primate Research Center, University of Washington, Seattle, Washington; and
| | - Amy L Nowack
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington; National Primate Research Center, University of Washington, Seattle, Washington; and
| | - Justin S Golub
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington
| | - Jay T Rubinstein
- Department of Otolaryngology-HNS, University of Washington, Seattle, Washington; Department of Bioengineering, University of Washington, Seattle, Washington; National Primate Research Center, University of Washington, Seattle, Washington; and Virginia Merrill Bloedel Hearing Research Center, University of Washington, Seattle, Washington
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32
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Abstract
Sensory systems encode the environment in egocentric (e.g., eye, head, or body) reference frames, creating inherently unstable representations that shift and rotate as we move. However, it is widely speculated that the brain transforms these signals into an allocentric, gravity-centered representation of the world that is stable and independent of the observer's spatial pose. Where and how this representation may be achieved is currently unknown. Here we demonstrate that a subpopulation of neurons in the macaque caudal intraparietal area (CIP) visually encodes object tilt in nonegocentric coordinates defined relative to the gravitational vector. Neuronal responses to the tilt of a visually presented planar surface were measured with the monkey in different spatial orientations (upright and rolled left/right ear down) and then compared. This revealed a continuum of representations in which planar tilt was encoded in a gravity-centered reference frame in approximately one-tenth of the comparisons, intermediate reference frames ranging between gravity-centered and egocentric in approximately two-tenths of the comparisons, and in an egocentric reference frame in less than half of the comparisons. Altogether, almost half of the comparisons revealed a shift in the preferred tilt and/or a gain change consistent with encoding object orientation in nonegocentric coordinates. Through neural network modeling, we further show that a purely gravity-centered representation of object tilt can be achieved directly from the population activity of CIP-like units. These results suggest that area CIP may play a key role in creating a stable, allocentric representation of the environment defined relative to an "earth-vertical" direction.
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33
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Dieterich M, Brandt T. The bilateral central vestibular system: its pathways, functions, and disorders. Ann N Y Acad Sci 2015; 1343:10-26. [DOI: 10.1111/nyas.12585] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marianne Dieterich
- Department of Neurology; Ludwig-Maximilians-University Munich; München Germany
- German Center for Vertigo and Balance Disorders-IFB; Ludwig-Maximilians-University Munich; München Germany
- Munich Cluster for Systems Neurology (SyNergy); Munich Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders-IFB; Ludwig-Maximilians-University Munich; München Germany
- Clinical Neuroscience, Ludwig-Maximilians-University Munich; München Germany
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34
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Kirsch V, Keeser D, Hergenroeder T, Erat O, Ertl-Wagner B, Brandt T, Dieterich M. Structural and functional connectivity mapping of the vestibular circuitry from human brainstem to cortex. Brain Struct Funct 2015; 221:1291-308. [PMID: 25552315 DOI: 10.1007/s00429-014-0971-x] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 12/17/2014] [Indexed: 11/29/2022]
Abstract
Structural and functional interconnections of the bilateral central vestibular network have not yet been completely delineated. This includes both ipsilateral and contralateral pathways and crossing sites on the way from the vestibular nuclei via the thalamic relay stations to multiple "vestibular cortex" areas. This study investigated "vestibular" connectivity in the living human brain in between the vestibular nuclei and the parieto-insular vestibular cortex (PIVC) by combined structural and functional connectivity mapping using diffusion tensor imaging and functional connectivity magnetic resonance imaging in 24 healthy right-handed volunteers. We observed a congruent functional and structural link between the vestibular nuclei and the ipsilateral and contralateral PIVC. Five separate and distinct vestibular pathways were identified: three run ipsilaterally, while the two others cross either in the pons or the midbrain. Two of the ipsilateral projections run through the posterolateral or paramedian thalamic subnuclei, while the third bypasses the thalamus to reach the inferior part of the insular cortex directly. Both contralateral pathways travel through the posterolateral thalamus. At the cortical level, the PIVC regions of both hemispheres with a right hemispherical dominance are interconnected transcallosally through the antero-caudal splenium. The above-described bilateral vestibular circuitry in its entirety takes the form of a structure of a rope ladder extending from the brainstem to the cortex with three crossings in the brainstem (vestibular nuclei, pons, midbrain), none at thalamic level and a fourth cortical crossing through the splenium of the corpus callosum.
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Affiliation(s)
- V Kirsch
- Department of Neurology, University Hospital, Ludwig-Maximilians University, Marchioninistraße 15, 81377, Munich, Germany. .,Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany. .,German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians University, Munich, Germany.
| | - D Keeser
- Department of Radiology, Ludwig-Maximilians University, Munich, Germany.,Department of Psychiatry, Ludwig-Maximilians University, Munich, Germany
| | - T Hergenroeder
- Department of Neurology, University Hospital, Ludwig-Maximilians University, Marchioninistraße 15, 81377, Munich, Germany
| | - O Erat
- Department of Neurology, University Hospital, Ludwig-Maximilians University, Marchioninistraße 15, 81377, Munich, Germany
| | - B Ertl-Wagner
- German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians University, Munich, Germany.,Department of Radiology, Ludwig-Maximilians University, Munich, Germany
| | - T Brandt
- German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians University, Munich, Germany.,Clinical Neuroscience, Ludwig-Maximilians University, 81377, Munich, Germany
| | - M Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians University, Marchioninistraße 15, 81377, Munich, Germany.,Graduate School of Systemic Neuroscience, Ludwig-Maximilians University, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFBLMU, Ludwig-Maximilians University, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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35
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Baier B, Müller N, Rhode F, Dieterich M. Vestibular compensation in cerebellar stroke patients. Eur J Neurol 2014; 22:416-8. [PMID: 24943045 DOI: 10.1111/ene.12475] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/23/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE There is little evidence about the site where compensatory vestibular mechanisms in patients with cerebellar strokes take place. METHODS To determine whether the location of a cerebellar lesion might be a crucial variable in vestibular compensation a sample of 22 patients with cerebellar stroke were tested for graviceptive function in the acute and chronic stage. RESULTS Our statistical anatomical lesion analysis indicated that mainly lesions of the cerebellar hemispheres (lobule V, VI, VIIa) hinder vestibular compensation and might lead to an overcompensation. CONCLUSIONS Overcompensation-induced dysfunction can be explained by the absence of cerebellar inhibitory signals.
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Affiliation(s)
- B Baier
- Department of Neurology, Mainz University, Mainz, Germany
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36
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Brandt T, Strupp M, Dieterich M. Towards a concept of disorders of "higher vestibular function". Front Integr Neurosci 2014; 8:47. [PMID: 24917796 PMCID: PMC4041089 DOI: 10.3389/fnint.2014.00047] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/18/2014] [Indexed: 12/02/2022] Open
Abstract
Background: Vestibular disorders are commonly characterized by a combination of perceptual, ocular motor, postural, and vegetative manifestations, which cause the symptoms of vertigo, nystagmus, ataxia, and nausea. Multisensory convergence and numerous polysynaptic pathways link the bilaterally organized central vestibular network with limbic, hippocampal, cerebellar, and non-vestibular cortex structures to mediate “higher” cognitive functions. Anatomical classification of vestibular disorders: The traditional classification of vestibular disorders is based on the anatomical site of the lesion. While it distinguishes between the peripheral and the central vestibular systems, certain weaknesses become apparent when applied clinically. There are two reasons for this: first, peripheral and central vestibular disorders cannot always be separated by the clinical syndrome; second, a third category, namely disorders of “higher vestibular function”, is missing. These disorders may be caused by peripheral as well as central vestibular lesions. Functional classification: Here we discuss a new concept of disorders of higher vestibular function which involve cognition and more than one sensory modality. Three conditions are described that exemplify such higher disorders: room tilt illusion, spatial hemineglect, and bilateral vestibulopathy all of which present with deficits of orientation and spatial memory. Conclusions: Further elaboration of such disorders of higher multisensory functions with respect to lesion site and symptomatology is desirable. The room tilt illusion and spatial hemineglect involve vestibular and visual function to the extent that both conditions can be classified as either disorders of higher vestibular or of higher visual functions. A possible way of separating these disorders in a first step is to determine whether the causative lesion site affects the vestibular or the visual system. For the vestibular system this lesion site may be peripheral or central. The criterion of “higher function” is fulfilled if cognition or senses other than the primarily affected one come into play.
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Affiliation(s)
- Thomas Brandt
- German Center for Vertigo and Balance Disorders, University of Grosshadern Munich Munich, Germany ; Clinical Neurosciences, University of Grosshadern Munich Munich, Germany
| | - Michael Strupp
- German Center for Vertigo and Balance Disorders, University of Grosshadern Munich Munich, Germany ; Department of Neurology, University of Munich Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, University of Grosshadern Munich Munich, Germany ; Department of Neurology, University of Munich Munich, Germany ; Munich Cluster of Systems Neurology, SyNergy Munich, Germany
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37
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Göttlich M, Jandl NM, Wojak JF, Sprenger A, von der Gablentz J, Münte TF, Krämer UM, Helmchen C. Altered resting-state functional connectivity in patients with chronic bilateral vestibular failure. NEUROIMAGE-CLINICAL 2014; 4:488-99. [PMID: 24818075 PMCID: PMC3984447 DOI: 10.1016/j.nicl.2014.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 02/26/2014] [Accepted: 03/09/2014] [Indexed: 12/30/2022]
Abstract
Patients with bilateral vestibular failure (BVF) suffer from gait unsteadiness, oscillopsia and impaired spatial orientation. Brain imaging studies applying caloric irrigation to patients with BVF have shown altered neural activity of cortical visual-vestibular interaction: decreased bilateral neural activity in the posterior insula and parietal operculum and decreased deactivations in the visual cortex. It is unknown how this affects functional connectivity in the resting brain and how changes in connectivity are related to vestibular impairment. We applied a novel data driven approach based on graph theory to investigate altered whole-brain resting-state functional connectivity in BVF patients (n= 22) compared to age- and gender-matched healthy controls (n= 25) using resting-state fMRI. Changes in functional connectivity were related to subjective (vestibular scores) and objective functional parameters of vestibular impairment, specifically, the adaptive changes during active (self-guided) and passive (investigator driven) head impulse test (HIT) which reflects the integrity of the vestibulo-ocular reflex (VOR). BVF patients showed lower bilateral connectivity in the posterior insula and parietal operculum but higher connectivity in the posterior cerebellum compared to controls. Seed-based analysis revealed stronger connectivity from the right posterior insula to the precuneus, anterior insula, anterior cingulate cortex and the middle frontal gyrus. Excitingly, functional connectivity in the supramarginal gyrus (SMG) of the inferior parietal lobe and posterior cerebellum correlated with the increase of VOR gain during active as compared to passive HIT, i.e., the larger the adaptive VOR changes the larger was the increase in regional functional connectivity. Using whole brain resting-state connectivity analysis in BVF patients we show that enduring bilateral deficient or missing vestibular input leads to changes in resting-state connectivity of the brain. These changes in the resting brain are robust and task-independent as they were found in the absence of sensory stimulation and without a region-related a priori hypothesis. Therefore they may indicate a fundamental disease-related change in the resting brain. They may account for the patients' persistent deficits in visuo-spatial attention, spatial orientation and unsteadiness. The relation of increasing connectivity in the inferior parietal lobe, specifically SMG, to improvement of VOR during active head movements reflects cortical plasticity in BVF and may play a clinical role in vestibular rehabilitation.
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Affiliation(s)
- Martin Göttlich
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
| | - Nico M Jandl
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
| | - Jann F Wojak
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
| | - Andreas Sprenger
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
| | | | - Thomas F Münte
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
| | - Ulrike M Krämer
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
| | - Christoph Helmchen
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany
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38
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Pérennou D, Piscicelli C, Barbieri G, Jaeger M, Marquer A, Barra J. Measuring verticality perception after stroke: Why and how? Neurophysiol Clin 2014; 44:25-32. [PMID: 24502902 DOI: 10.1016/j.neucli.2013.10.131] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 10/12/2013] [Indexed: 11/15/2022] Open
Affiliation(s)
- D Pérennou
- Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France.
| | - C Piscicelli
- Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France
| | - G Barbieri
- Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France
| | - M Jaeger
- Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France
| | - A Marquer
- Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France
| | - J Barra
- Clinique MPR-CHU, Laboratoire TIMC-IMAG CNRS 5525 Equipe Santé-Plasticité-Motricité, Université Grenoble 1, Hôpital Sud, CHU, avenue de Kimberley, BP 338, 38000 Grenoble, France; Université Paris Descartes, laboratoire de Psychologie et Neuropsychologie Cognitive, FRE 3292, 71, avenue Edouard-Vaillant, 92100 Boulogne Billancourt, France
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39
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Seilheimer RL, Rosenberg A, Angelaki DE. Models and processes of multisensory cue combination. Curr Opin Neurobiol 2013; 25:38-46. [PMID: 24709599 DOI: 10.1016/j.conb.2013.11.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/26/2013] [Accepted: 11/18/2013] [Indexed: 01/13/2023]
Abstract
Fundamental to our perception of a unified and stable environment is the capacity to combine information across the senses. Although this process appears seamless as an adult, the brain's ability to successfully perform multisensory cue combination takes years to develop and relies on a number of complex processes including cue integration, cue calibration, causal inference, and reference frame transformations. Further complexities exist because multisensory cue combination is implemented across time by populations of noisy neurons. In this review, we discuss recent behavioral studies exploring how the brain combines information from different sensory systems, neurophysiological studies relating behavior to neuronal activity, and a theory of neural sensory encoding that can account for many of these experimental findings.
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Affiliation(s)
| | - Ari Rosenberg
- Baylor College of Medicine, Houston, TX, United States
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40
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Abstract
PURPOSE OF REVIEW This article reviews and updates basic concepts, diagnosis and treatment of cyclotorsion. RECENT FINDINGS Cyclodeviation in congenital superior oblique palsy (SOP) seems to correlate with the extent of superior oblique muscle hypoplasia. Genetic polymorphisms such as PHOX2B polymorphism, considered to be risk factors for congenital fibrosis of the extraocular muscles, may play a role in SOP and consequently in cyclotorsion. Two components of the ocular tilt reaction, ocular torsion and tilt of subjective visual vertical, seem to share similar sites of impairment in the brainstem. Harada-Ito surgery continues to be the procedure of choice in patients with isolated cyclodeviation, evidencing better outcome if less than 10° of preoperative excyclotorsion and preoperative fusion exist. Ocular torsion is not infrequent in patients with intermittent exotropia, especially in the most exo-deviated eye, emphasizing a possible role in pathogenesis. A new device for the assessment of dynamic torsion during ocular counter roll response using after-image has been described. Similarly, a new method to measure objective ocular torsion using retinal arcade tilt as a reference has been proposed. Finally, torsional data transformation such as the sum of angles of excyclodeviation, rather than using the angle of excyclodeviation of the paretic eye, is becoming increasingly popular among studies on torsion. SUMMARY Exciting developments on ocular torsion have been described recently, and new ways to access and interpret ocular torsion have been devised as well.
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Affiliation(s)
- João Lemos
- Michigan State University, East Lansing, Michigan, USA
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