Global multisensory reorganization after vestibular brain stem stroke
Abstract Objective Patients with acute central vestibular syndrome suffer from vertigo, spontaneous nystagmus, postural instability with lateral falls, and tilts of visual vertical. Usually, these symptoms compensate within months. The mechanisms of compensation in vestibular infarcts are yet unclea...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2020-10-01
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| Series: | Annals of Clinical and Translational Neurology |
| Online Access: | https://doi.org/10.1002/acn3.51161 |
| _version_ | 1819094461331800064 |
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| author | Julian Conrad Maximilian Habs Rainer Boegle Matthias Ertl Valerie Kirsch Iskra Stefanova‐Brostek Ozan Eren Sandra Becker‐Bense Thomas Stephan Frank Wollenweber Marco Duering Peter zu Eulenburg Marianne Dieterich |
| author_facet | Julian Conrad Maximilian Habs Rainer Boegle Matthias Ertl Valerie Kirsch Iskra Stefanova‐Brostek Ozan Eren Sandra Becker‐Bense Thomas Stephan Frank Wollenweber Marco Duering Peter zu Eulenburg Marianne Dieterich |
| author_sort | Julian Conrad |
| collection | DOAJ |
| description | Abstract Objective Patients with acute central vestibular syndrome suffer from vertigo, spontaneous nystagmus, postural instability with lateral falls, and tilts of visual vertical. Usually, these symptoms compensate within months. The mechanisms of compensation in vestibular infarcts are yet unclear. This study focused on structural changes in gray and white matter volume that accompany clinical compensation. Methods We studied patients with acute unilateral brain stem infarcts prospectively over 6 months. Structural changes were compared between the acute phase and follow‐up with a group of healthy controls using voxel‐based morphometry. Results Restitution of vestibular function following brain stem infarcts was accompanied by downstream structural changes in multisensory cortical areas. The changes depended on the location of the infarct along the vestibular pathways in patients with pathological tilts of the SVV and on the quality of the vestibular percept (rotatory vs graviceptive) in patients with pontomedullary infarcts. Patients with pontomedullary infarcts with vertigo or spontaneous nystagmus showed volumetric increases in vestibular parietal opercular multisensory and (retro‐) insular areas with right‐sided preference. Compensation of graviceptive deficits was accompanied by adaptive changes in multiple multisensory vestibular areas in both hemispheres in lower brain stem infarcts and by additional changes in the motor system in upper brain stem infarcts. Interpretation This study demonstrates multisensory neuroplasticity in both hemispheres along with the clinical compensation of vestibular deficits following unilateral brain stem infarcts. The data further solidify the concept of a right‐hemispheric specialization for core vestibular processing. The identification of cortical structures involved in central compensation could serve as a platform to launch novel rehabilitative treatments such as transcranial stimulations. |
| first_indexed | 2024-12-21T23:27:46Z |
| format | Article |
| id | doaj.art-89df2a744f9d4ccc8b906f576f88b487 |
| institution | Directory Open Access Journal |
| issn | 2328-9503 |
| language | English |
| last_indexed | 2024-12-21T23:27:46Z |
| publishDate | 2020-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Clinical and Translational Neurology |
| spelling | doaj.art-89df2a744f9d4ccc8b906f576f88b4872022-12-21T18:46:35ZengWileyAnnals of Clinical and Translational Neurology2328-95032020-10-017101788180110.1002/acn3.51161Global multisensory reorganization after vestibular brain stem strokeJulian Conrad0Maximilian Habs1Rainer Boegle2Matthias Ertl3Valerie Kirsch4Iskra Stefanova‐Brostek5Ozan Eren6Sandra Becker‐Bense7Thomas Stephan8Frank Wollenweber9Marco Duering10Peter zu Eulenburg11Marianne Dieterich12Department of Neurology University HospitalLMU Munich Munich GermanyDepartment of Neurology University HospitalLMU Munich Munich GermanyDepartment of Neurology University HospitalLMU Munich Munich GermanyDepartment of Neurology University HospitalLMU Munich Munich GermanyDepartment of Neurology University HospitalLMU Munich Munich GermanyDepartment of Neurology Muenchen Klinik Harlaching GermanyDepartment of Neurology University HospitalLMU Munich Munich GermanyGerman Center for Vertigo and Balance Disorders (DSGZ) University HospitalLMU Munich Munich GermanyDepartment of Neurology University HospitalLMU Munich Munich GermanyInstitute for Stroke and Dementia Research (ISD) University HospitalLMU Munich Munich GermanyInstitute for Stroke and Dementia Research (ISD) University HospitalLMU Munich Munich GermanyGerman Center for Vertigo and Balance Disorders (DSGZ) University HospitalLMU Munich Munich GermanyDepartment of Neurology University HospitalLMU Munich Munich GermanyAbstract Objective Patients with acute central vestibular syndrome suffer from vertigo, spontaneous nystagmus, postural instability with lateral falls, and tilts of visual vertical. Usually, these symptoms compensate within months. The mechanisms of compensation in vestibular infarcts are yet unclear. This study focused on structural changes in gray and white matter volume that accompany clinical compensation. Methods We studied patients with acute unilateral brain stem infarcts prospectively over 6 months. Structural changes were compared between the acute phase and follow‐up with a group of healthy controls using voxel‐based morphometry. Results Restitution of vestibular function following brain stem infarcts was accompanied by downstream structural changes in multisensory cortical areas. The changes depended on the location of the infarct along the vestibular pathways in patients with pathological tilts of the SVV and on the quality of the vestibular percept (rotatory vs graviceptive) in patients with pontomedullary infarcts. Patients with pontomedullary infarcts with vertigo or spontaneous nystagmus showed volumetric increases in vestibular parietal opercular multisensory and (retro‐) insular areas with right‐sided preference. Compensation of graviceptive deficits was accompanied by adaptive changes in multiple multisensory vestibular areas in both hemispheres in lower brain stem infarcts and by additional changes in the motor system in upper brain stem infarcts. Interpretation This study demonstrates multisensory neuroplasticity in both hemispheres along with the clinical compensation of vestibular deficits following unilateral brain stem infarcts. The data further solidify the concept of a right‐hemispheric specialization for core vestibular processing. The identification of cortical structures involved in central compensation could serve as a platform to launch novel rehabilitative treatments such as transcranial stimulations.https://doi.org/10.1002/acn3.51161 |
| spellingShingle | Julian Conrad Maximilian Habs Rainer Boegle Matthias Ertl Valerie Kirsch Iskra Stefanova‐Brostek Ozan Eren Sandra Becker‐Bense Thomas Stephan Frank Wollenweber Marco Duering Peter zu Eulenburg Marianne Dieterich Global multisensory reorganization after vestibular brain stem stroke Annals of Clinical and Translational Neurology |
| title | Global multisensory reorganization after vestibular brain stem stroke |
| title_full | Global multisensory reorganization after vestibular brain stem stroke |
| title_fullStr | Global multisensory reorganization after vestibular brain stem stroke |
| title_full_unstemmed | Global multisensory reorganization after vestibular brain stem stroke |
| title_short | Global multisensory reorganization after vestibular brain stem stroke |
| title_sort | global multisensory reorganization after vestibular brain stem stroke |
| url | https://doi.org/10.1002/acn3.51161 |
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