Multisensory vestibular cortex activated by otolith stimulation (fMRI)

Dominance for Vestibular Cortical Function in the Non-dominant Hemisphere

The aim of this (15)O-labelled H(2)O bolus positron emission tomography (PET) study was to analyse the hemispheric dominance of the vestibular cortical system. Therefore, the differential effects of caloric vestibular stimulation (right or left ear irrigation with warm water at 44 degrees C) on cortical and subcortical activation were studied in 12 right-handed and 12 left-handed healthy volunteers. Caloric irrigation induces a direction-specific sensation of rotation and nystagmus. Significant regional cerebral blood flow increases were found in a network within both hemispheres, including the superior frontal gyrus/sulcus, the precentral gyrus and the inferior parietal lobule with the sup…

Changes in cerebellar activation pattern during two successive sequences of saccades

The changes in the cerebellar activation pattern of two successive fMRI scanning runs were determined for visually guided to‐and‐fro saccades in 12 healthy volunteers familiar with the study paradigm. Group and single subject‐analyses revealed a constant activation of the paramedian cerebellar vermis (uvula, tonsils, tuber, folium/declive), which reflects constant ocular motor activity in both runs. A significant decrease in activation of the cerebellar hemispheres found in the second run is best explained by either a decrease in attention or the effects of motor optimization and learning. The significant, systematic changes of the cerebellar activation pattern in two successive runs were n…

Neural correlates of hemispheric dominance and ipsilaterality within the vestibularsystem

Earlier functional imaging studies on the processing of vestibular information mainly focused on cortical activations due to stimulation of the horizontal semicircular canals in right-handers. Two factors were found to determine its processing in the temporo-parietal cortex: a dominance of the non-dominant hemisphere and an ipsilaterality of the neural pathways. In an investigation of the role of these factors in the vestibular otoliths, we used vestibular evoked myogenic potentials (VEMPs) in a fMRI study of monaural saccular-otolith stimulation. Our aim was to (1) analyze the hemispheric dominance for saccular-otolith information in healthy left-handers, (2) determine if there is a predom…

Fixation suppression of optokinetic nystagmus modulates cortical visual-vestibular interaction.

Water activation positron emission tomography and statistical group analysis were used to evaluate differences in activation-deactivation patterns during small-field visual motion stimulation, eliciting rightward optokinetic nystagmus and its fixation suppression in 12 healthy volunteers. Bilateral patterns of activation in the visual cortex, including the motion-sensitive area MT/V5, and deactivations in an assembly of vestibular areas (posterior insula, thalamus, anterior cingulate gyrus) during optokinetic nystagmus was markedly diminished or totally absent during its fixation suppression. This finding agrees with the concept of a reciprocal inhibitory interaction between the visual-opto…

Vestibular dysfunction in major depression

Acute Vestibular Nucleus Lesion Affects Cortical Activation Pattern during Caloric Irrigation in PET

Medial Vestibular Nucleus Lesions in Wallenberg's Syndrome Cause Decreased Activity of the Contralateral Vestibular Cortex

Three patients with the clinical diagnosis of Wallenberg's syndrome caused by acute unilateral ischemic infarctions, which included the vestibular nucleus in the medullary brain stem and afferent vestibular pathways, were examined by positron emission tomography (PET) during caloric vestibular stimulation. They all had typical signs of vestibular dysfunction such as transient rotatory vertigo with vomiting at the onset, ipsiversive body and ocular lateropulsion, and a complete ocular tilt reaction with tilts of the subjective visual vertical. Compared with healthy volunteers, who show activation in a network of temporoparietal vestibular areas within both hemispheres, especially in the post…

Inhibitory interhemispheric visuovisual interaction in motion perception.

Findings of an earlier functional magnetic resonance imaging (fMRI) study that coherent motion stimulation of the right or left visual hemifield exhibited negative signal changes (deactivations) in the primary visual cortex and the lateral geniculate nucleus contralateral to the stimulated hemisphere were evaluated to determine the functional significance of this contralateral inhibition of the visual system. Fourteen subjects participated in a psychophysical study on the perception of single object motion (0.4 degrees /s) in one visual hemifield with or without concurrent coherent motion stimulation of the contralateral hemifield. Mean detection times for horizontal object motion (0.5 +/- …

3.7. Are signs of ocular tilt reaction in cerebellar lesions mediated by the dentate nucleus?

Functional Magnetic Resonance Imaging Activations of Cortical Eye Fields during Saccades, Smooth Pursuit, and Optokinetic Nystagmus

Saccades, smooth pursuit, and optokinetic nystagmus (OKN) are three basic eye movements in our ocular motor repertoire that enable us to explore the visual field. These eye movements are cortically controlled in different cortical eye fields, including the frontal eye fields (FEF) and parietal eye fields (PEF), as well as the motion-sensitive visual area MT+/V5. It is not known if this cortical control is organized in parallel cortico-cortical networks or in adjacent subregions of one system. Nor do we know where the specific eye fields are exactly located. Functional magnetic resonance imaging (fMRI) was used to investigate these open questions about the FEF, PEF, and MT+/V5. Activations o…

Thalamic infarctions cause side-specific suppression of vestibular cortex activations.

H2O15-PET was performed during caloric vestibular stimulation of the right and left external ears in eight right-handed patients with acute unilateral infarctions or haemorrhages of the posterolateral thalamus (four right, four left). The posterolateral thalamus is the relay station for ipsi- and contralateral ascending vestibular input to the multiple multisensory vestibular cortex areas. The aim of this study was to evaluate the differential effects of unilateral vestibular thalamic lesions on thalamo-cortical projections, right hemispheric dominance and reciprocal inhibitory visual-vestibular interaction, as well as perceptual and ocular motor consequences during caloric irrigation. The …

Sensory system interactions during simultaneous vestibular and visual stimulation in PET

The patterns of regional cerebral blood flow (rCBF) increases and decreases in PET were compared for unimodal vestibular, unimodal visual, and for simultaneous vestibular and visual stimulation. Thirteen healthy volunteers were exposed to a) caloric vestibular stimulation, b) small-field visual motion stimulation in roll, c) simultaneous caloric vestibular and visual pattern stimulation. Unimodal vestibular stimulation led to activations of vestibular cortex areas, in particular the parieto-insular vestibular cortex (PIVC), and concurrent deactivations of visual cortical areas [Brodmann area (BA) 17-19]. Unimodal visual motion stimulation led to activations of the striate visual cortex and …

fMRI signal increases and decreases in cortical areas during small-field optokinetic stimulation and central fixation

Small-field optokinetic nystagmus (OKN) was performed in seven healthy volunteers in order to analyze the activation and deactivation patterns of visual motion, ocular motor, and multisensory vestibular cortex areas by means of fMRI during coherent visual motion stimulation. BOLD signal decreases (deactivations) were found in the first and second long insular gyri and retroinsular areas (the human homologue of the parietoinsular vestibular cortex and the visual posterior sylvian area in the monkey) of both hemispheres, extending into the transverse temporal gyrus and inferior-anterior parts of the superior temporal gyrus (BA 22), and the precentral gyri at two separate sites (BA 4 and 6). F…

Rollvection versus linearvection: Comparison of brain activations in PET

We conducted a PET study to directly compare the differential effects of visual motion stimulation that induced either rollvection about the line of sight or forward linearvection along this axis in the same subjects. The main question was, whether the areas that respond to vection are identical or separate and distinct for rollvection and linearvection. Eleven healthy volunteers were exposed to large-field (100 degrees x 60 degrees ) visual motion stimulation consisting of (1) dots accelerating from a focus of expansion to the edge of the screen (forward linearvection) and (2) dots rotating counterclockwise in the frontal plane (clockwise rollvection). These two stimuli, which induced appa…

Evidence for modulation of opioidergic activity in central vestibular processing: A [(18)F] diprenorphine PET study.

Animal and functional imaging studies had identified cortical structures such as the parieto‐insular vestibular cortex, the retro‐insular cortex, or the anterior cingulate cortex belonging to a vestibular cortical network. Basic animal studies revealed that endorphins might be important transmitters involved in cerebral vestibular processing. The aim of the present study was therefore to analyse whether the opioid system is involved in vestibular neurotransmission of humans or not. Changes in opioid receptor availability during caloric air stimulation of the right ear were studied with [(18)F] Fluoroethyl‐diprenorphine ([(18)F]FEDPN) PET scans in 10 right‐handed healthy volunteers and compa…

Interaction of somatoform and vestibular disorders

The high coincidence of organic vestibular and somatoform vertigo syndromes has appeared to support pathogenic models showing a strong linkage between them. It was hypothesised that a persisting vestibular dysfunction causes the development of anxiety disorders.To determine the relation between vestibular deficits and somatoform vertigo disorders in an interdisciplinary prospective study.Participants were divided into eight diagnostic groups: healthy volunteers (n=26) and patients with benign paroxysmal positioning vertigo (BPPV, n=11), vestibular neuritis (n=11), Menière's disease (n=7), vestibular migraine (n=15), anxiety (n=23), depression (n=12), or somatoform disorders (n=22). Neuro-ot…

Preserved visual-vestibular interaction in patients with bilateral vestibular failure

Background: During caloric vestibular stimulation, subjects showed bilateral activation of the vestibular cortex in the posterior insula and retroinsular region as well as concurrent deactivation of visual cortex areas bilaterally. This finding was the basis for the concept of a reciprocal inhibitory interaction between the vestibular and the visual systems. Objective: To analyze the modulations of this activation and deactivation pattern in patients with loss of vestibular input, that is, in patients with bilateral vestibular failure (BVF). Methods: Modulations of regional cerebral blood flow (rCBF) in PET were measured in nine patients with BVF and compared with those in healthy volunteer…

Are signs of ocular tilt reaction in patients with cerebellar lesions mediated by the dentate nucleus?

A sensitive clinical sign of a vestibular tone imbalance in the roll plane is the ocular tilt reaction (OTR), a combination of skew deviation, ocular torsion and head and perceptual tilts such as tilts of the subjective visual vertical (SVV). Of these OTR components tilts of SVV are the most frequent. While these signs are regularly seen in patients with unilateral brainstem lesions, only a few case studies are available on their occurrence in patients with cerebellar lesions. Thus, the question arises whether cerebellar structures may be involved in contra- and/or ipsiversive tilts of the perceived vertical and other signs of OTR. We used lesion-mapping techniques in a total of 31 patients…

Three Determinants of Vestibular Hemispheric Dominance during Caloric Stimulation: A Positron Emission Tomography Study

Metabolic changes in vestibular and visual cortices in acute vestibular neuritis

Five right-handed patients with a right-sided vestibular neuritis were examined twice with fluorodeoxyglucose positron emission tomography while lying supine with eyes closed: once during the acute stage (mean, 6.6 days) and then 3 months later when central vestibular compensation had occurred. Regional cerebral glucose metabolism (rCGM) was significantly increased (p <0.001 uncorrected) during the acute stage in multisensory vestibular cortical and subcortical areas (parietoinsular vestibular cortex in the posterior insula, posterolateral thalamus, anterior cingulate gyrus [Brodmann area 32/24], pontomesencephalic brainstem, hippocampus). Simultaneously, there was a significant rCGM decrea…

3.2. Brain stem and cerebellar activation during optokinetic stimulation

Direction‐dependent visual cortex activation during horizontal optokinetic stimulation (fMRI study)

Looking at a moving pattern induces optokinetic nystagmus (OKN) and activates an assembly of cortical areas in the visual cortex, including lateral occipitotemporal (motion‐sensitive area MT/V5) and adjacent occipitoparietal areas as well as ocular motor areas such as the prefrontal cortex, frontal, supplementary, and parietal eye fields. The aim of this functional MRI (fMRI) study was to investigate (1) whether stimulus direction‐dependent effects can be found, especially in the cortical eye fields, and (2) whether there is a hemispheric dominance of ocular motor areas. In a group of 15 healthy subjects, OKN in rightward and leftward directions was visually elicited and statistically compa…

P13. Compensation processes for central vestibular dysfunction in patients with acute medullary infarctions (FDG-PET study)

18F-fluorodeoxyglucose hypometabolism in cerebellar tonsil and flocculus in downbeat nystagmus.

A patient with downbeat nystagmus was examined by F-fluorodeoxyglucose-positron emission tomography once while off and twice while on successful treatment with 4-aminopyridine. All positron emission tomography scans of the patient showed a reduced cerebral glucose metabolism bilaterally in the region of the cerebellar tonsil and flocculus/paraflocculus when compared with a normal database of the whole brain. An additional region-of-interest analysis revealed that 4-aminopyridine treatment lessened the hypometabolism. This finding supports the hypothesis that the cerebellar tonsil and (para-) flocculus play a crucial role in downbeat nystagmus. The hypometabolism might reflect reduced inhibi…