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Preserved visual–vestibular interaction in patients with bilateral vestibular failure

From the Departments of Neurology (Drs. Bense and Dieterich) and Nuclear Medicine (Dr. Bartenstein), Johannes Gutenberg-University, Mainz, Department of Neurology (Drs. Bense, Deutschländer, Brandt, Dieterich, and Stephan), Ludwig-Maximilians University, and Department of Nuclear Medicine (Drs. Bartenstein and Schwaiger), Technical University, Munich, Germany.

Address correspondence and reprint requests to Dr. S. Bense Department of Neurology, Johannes Gutenberg-University of Mainz, Langenbeckstrasse 1, D-55101 Mainz, Germany; e-mail: bense{at}neurologie.klinik.uni-mainz.de

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 volunteers using statistical group as well as single-subject analyses (Statistical Parametric Mapping 96b).

Results: The group analysis of the BVF patients showed only one small region of activation in the posterior insula contralateral to the stimulated ear, whereas the other areas correlating with vestibular, autonomic, and ocular motor function were not activated. Furthermore, the concurrent rCBF decreases of the primary visual cortex seen in healthy volunteers were not found in the patients. These decreases seem to be dependent on an intact vestibular input with concurrent vestibular nystagmus.

Conclusions: The results are compatible with the concept of a reciprocal inhibitory sensorisensory interaction between the vestibular and visual systems that normally act together for orientation in space and perception of motion. This interaction appears to be preserved in the patients at a significantly lower level, that is, with less activation and less deactivation.

Received June 5, 2003. Accepted in final form March 2, 2004.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the July 13 issue to find the title link for this article.

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				M. Dieterich and T. Brandt Functional brain imaging of peripheral and central vestibular disorders Brain, May 30, 2008; (2008) awn042v1. [Abstract] [Full Text] [PDF]