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Dissociation of visual and haptic vertical in two patients with vestibular nuclear lesions

From the Academic Department of Neuro-otology (Drs. Bronstein, Pérennou, and Guerraz), Imperial College London; and National Hospital for Neurology and Neurosurgery (Drs. Playford and Rudge), Queen Square, London, UK.

Address correspondence and reprint requests to Professor A.M. Bronstein, Academic Department of Neuro-otology, Division of Neuroscience and Psychological Medicine, Imperial College London, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK; e-mail: a.bronstein{at}imperial.ac.uk

The somatosensory (haptic) vertical (HV) and visual vertical (VV) were assessed in two patients with vestibular nuclear lesions. Patient 1 had paroxysmal nystagmus, and was tested "on" and "off." The HV was normal "on" and "off" but the VV was severely tilted during vestibular paroxysms. Patient 2, with a brainstem stroke, was tested at months 1 and 6. The VV was severely tilted on both occasions (>12°) but the HV was marginally tilted (4°) in the acute stage only. These VV-HV dissociations suggest that vestibular nuclear lesions influence gravity perception mostly via ocular torsional effects rather than by disrupting a single, internal representation of verticality.

Received February 11, 2003. Accepted in final form June 14, 2003.

See also page 1172

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