Parieto-insular Vestibular Cortex Research Articles

Functional neuroanatomy of the vestibular cortex and vestibular stimulation methods for neuroimaging studies

The vestibular cortex is a distributed network of multisensory areas that plays a crucial role in balance, posture, and spatial orientation. The core region of the vestibular cortex is the parietoinsular vestibular cortex (PIVC), which is located at the junction between the posterior insula, parietal operculum, and retroinsular region. The PIVC is connected to other vestibular areas, the primary and secondary somatosensory cortices, and the premotor and posterior parietal cortices. It also sends projections to the vestibular nuclei in the brainstem. The PIVC is a multisensory region that integrates vestibular, visual, and somatosensory information to create a representation of head-in-space motion, which is used to control eye movements, posture, and balance. Other regions of the vestibular cortex include the primary somatosensory, posterior parietal, and frontal cortices. The primary somatosensory cortex is involved in processing information about touch and body position. The posterior parietal cortex is involved in integrating vestibular, visual, and somatosensory information to create a representation of spatial orientation. The frontal cortex is involved in controlling posture, and eye movements. The various methods used to stimulate the vestibular receptors in neuroimaging studies include caloric vestibular stimulation (CVS), galvanic vestibular stimulation (GVS), and auditory vestibular stimulation (AVS). CVS uses warm or cold water or air to stimulate the semicircular canals, GVS uses a weak electrical current to stimulate the vestibular nerve, and AVS uses high-intensity clicks or short tone bursts to stimulate the otolithic receptors.

Frequency-dependent tuning of the human vestibular “sixth sense” by transcranial oscillatory currents

ObjectiveThe vestibular cortex is a multisensory associative region that, in neuroimaging investigations, is activated by slow-frequency (1–2 Hz) galvanic stimulation of peripheral receptors. We aimed to directly activate the vestibular cortex with biophysically modeled transcranial oscillatory current stimulation (tACS) in the same frequency range. MethodsThirty healthy subjects and one rare patient with chronic bilateral vestibular deafferentation underwent, in a randomized, double-blind, controlled trial, to tACS at slow (1 or 2 Hz) or higher (10 Hz) frequency and sham stimulations, over the Parieto-Insular Vestibular Cortex (PIVC), while standing on a stabilometric platform. Subjective symptoms of motion sickness were scored by Simulator Sickness Questionnaire and subjects’ postural sways were monitored on the platform. ResultstACS at 1 and 2 Hz induced symptoms of motion sickness, oscillopsia and postural instability, that were supported by posturographic sway recordings. Both 10 Hz-tACS and sham stimulation on the vestibular cortex did not affect vestibular function. As these effects persisted in a rare patient with bilateral peripheral vestibular areflexia documented by the absence of the Vestibular-Ocular Reflex, the possibility of a current spread toward peripheral afferents is unlikely. Conversely, the 10 Hz-tACS significantly reduced his chronic vestibular symptoms in this patient. ConclusionsWeak electrical oscillations in a frequency range corresponding to the physiological cortical activity of the vestibular system may generate motion sickness and postural sways, both in healthy subjects and in the case of bilateral vestibular deafferentation. SignificanceThis should be taken into account as a new side effect of tACS in future studies addressing cognitive functions. Higher frequencies of stimulation applied to the vestibular cortex may represent a new interventional option to reduce motion sickness in different scenarios.

Vestibular and visual brain areas in the medial cortex of the human brain.

Self-motion perception involves an interaction between vestibular and visual brain regions. In the lateral brain, it includes the parietoinsular vestibular cortex and the posterior insular cortex. In the medial cortex, the cingulate sulcus visual (CSv) area is known to process visual-vestibular cues. Here, we show that the vestibular-visual network of the medial cortex extends beyond area CSv. We examined brain activations of 36 healthy right-handed participants by functional magnetic resonance imaging (fMRI) during stimulation with caloric vestibular, thermal, or visual motion cues. Consistent with previous research, we found that area CSv responded to both vestibular and visual cues but not to thermal cues. Moreover, the V6 complex and the precuneus motion (PcM) area responded primarily to (laminar-translational) visual motion cues. However, we also observed a region inferior to CSv within the pericallosal sulcus (vicinity of anterior retrosplenial) that primarily responded to vestibular cues. This vestibular pericallosal sulcus (vPCS) region did not respond to either visual or thermal cues. It was also distinct from a more posterior motion-sensitive region in the retrosplenial complex (mRSC) that responded to (radial) visual motion but not to vestibular and thermal cues. Together, our results suggest that the vestibular-visual network in the medial cortex not only includes areas CSv, PcM, and the V6 complex but also two additional brain regions adjacent to the callosum. These two brain regions exhibit similarities in terms of their locations and responses to vestibular and visual cues with self-motion-related brain regions recently described in nonhuman primates.NEW & NOTEWORTHY Self-motion perception involves several vestibular and visual cortical regions. Within the medial cortex, the cingulate sulcus visual (CSv) area, the precuneus motion (PcM) area, and the V6 complex respond selectively to self-motion cues. Here, we show that vestibular information is also processed in the pericallosal sulcus (vPCS), whereas (radial) visual motion information is associated with activation in the retrosplenial cortex (mRSC).

Contrary neuronal recalibration in different multisensory cortical areas.

The adult brain demonstrates remarkable multisensory plasticity by dynamically recalibrating itself based on information from multiple sensory sources. After a systematic visual-vestibular heading offset is experienced, the unisensory perceptual estimates for subsequently presented stimuli are shifted toward each other (in opposite directions) to reduce the conflict. The neural substrate of this recalibration is unknown. Here, we recorded single-neuron activity from the dorsal medial superior temporal (MSTd), parietoinsular vestibular cortex (PIVC), and ventral intraparietal (VIP) areas in three male rhesus macaques during this visual-vestibular recalibration. Both visual and vestibular neuronal tuning curves in MSTd shifted - each according to their respective cues' perceptual shifts. Tuning of vestibular neurons in PIVC also shifted in the same direction as vestibular perceptual shifts (cells were not robustly tuned to the visual stimuli). By contrast, VIP neurons demonstrated a unique phenomenon: both vestibular and visual tuning shifted in accordance with vestibular perceptual shifts. Such that, visual tuning shifted, surprisingly, contrary to visual perceptual shifts. Therefore, while unsupervised recalibration (to reduce cue conflict) occurs in early multisensory cortices, higher-level VIP reflects only a global shift, in vestibular space.

Comparative study of vestibular projection pathway connectivity in cerebellar injury patients and healthy adults

ObjectiveCerebellar injury can not only cause gait and postural instability, nystagmus, and vertigo but also affect the vestibular system. However, changes in connectivity regarding the vestibular projection pathway after cerebellar injury have not yet been reported. Therefore, in the current study, we investigated differences in the connectivity of the vestibular projection pathway after cerebellar injury using diffusion tensor imaging (DTI) tractography.MethodsWe recruited four stroke patients with cerebellar injury. Neural connectivity in the vestibular nucleus (VN) of the pons and medulla oblongata in patients with cerebellar injury was measured using DTI. Connectivity was defined as the incidence of connection between the VN on the pons and medulla oblongata and target brain regions such as the cerebellum, thalamus, parieto-insular vestibular cortex (PIVC), and parietal lobe.ResultsAt thresholds of 10 and 30, there was lower connectivity in the ipsilateral hemisphere between the VN at the medullar level and thalamus in the patients than in healthy adults. At a threshold of 1 and 10, the patient group showed lower VN connectivity with the PIVC than healthy adults. At a threshold of 1, VN connectivity with the parietal lobe in the contralateral hemisphere was lower in the patients than in healthy adults. Additionally, at a threshold of 30, VN connectivity at the pons level with the cerebellum was lower in healthy adults than in the patients.ConclusionCerebellar injury seems to be associated with decreased vestibular projection pathway connectivity, especially in the ipsilateral thalamus, PIVC, and contralateral parietal lobe.

Associations Between Injury of the Parieto-Insular Vestibular Cortex and Changes in Motor Function According to the Recovery Process: Use of Diffusion Tensor Imaging.

Background and Purpose: Parieto-insular vestibular cortex (PIVC) injury can cause symptoms such as abnormal gait and affects the integration and processing of sensory inputs contributing to self-motion perception. Therefore, this study investigated the association of the vestibular pathway in the gait and motor function recovery process in patients with PIVC injury using diffusion tensor imaging (DTI).Methods: We recruited 28 patients with stroke with only PIVC injury and reconstructed the PIVC using a 1.5-T scanner for DTI. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. The functional ambulatory category (FAC) test was conducted, and motricity index (MI) score was determined. These were conducted and determined at the start (phase 1), end of rehabilitation (phase 2), and during the follow-up 6 months after onset.Results: Although the tract volume of PIVC showed a decrease in subgroup A, all of DTI parameters were not different between two subgroups in affected side (p > 0.05). The results of MI and FAC were significantly different according to the recovery process (p < 0.05). In addition, FA of the PIVC showed a positive correlation with FAC in phase 2 of the recovery process on the affected side. On the unaffected side, FA of the PIVC showed a significant negative correlation with MI in all processes (p < 0.05).Conclusion: The degree of projection pathways to PIVC injury at onset time seems to be related to early restoration of gait function. Moreover, we believe that early detection of the projection pathway for PIVC injury using DTI would be helpful in the clinical evaluation and prediction of the prognosis of patients with PIVC injury.

Vestibular Stimulation May Drive Multisensory Processing: Principles for Targeted Sensorimotor Therapy (TSMT).

At birth, the vestibular system is fully mature, whilst higher order sensory processing is yet to develop in the full-term neonate. The current paper lays out a theoretical framework to account for the role vestibular stimulation may have driving multisensory and sensorimotor integration. Accordingly, vestibular stimulation, by activating the parieto-insular vestibular cortex, and/or the posterior parietal cortex may provide the cortical input for multisensory neurons in the superior colliculus that is needed for multisensory processing. Furthermore, we propose that motor development, by inducing change of reference frames, may shape the receptive field of multisensory neurons. This, by leading to lack of spatial contingency between formally contingent stimuli, may cause degradation of prior motor responses. Additionally, we offer a testable hypothesis explaining the beneficial effect of sensory integration therapies regarding attentional processes. Key concepts of a sensorimotor integration therapy (e.g., targeted sensorimotor therapy (TSMT)) are also put into a neurological context. TSMT utilizes specific tools and instruments. It is administered in 8-weeks long successive treatment regimens, each gradually increasing vestibular and postural stimulation, so sensory-motor integration is facilitated, and muscle strength is increased. Empirically TSMT is indicated for various diseases. Theoretical foundations of this sensorimotor therapy are discussed.

Altered Gray Matter Volume and Functional Connectivity in Patients With Vestibular Migraine

SubjectsVestibular migraine (VM) is the most common neurological cause of vertigo in adults. Previous neuroimaging studies have reported structural alterations in areas associated with pain and vestibular processing. However, it is unclear whether altered resting-state functional connectivity (FC) exists in brain regions with structural abnormalities in patients with VM.MethodsResting-state functional magnetic resonance imaging (MRI) and three-dimensional T1-weighed MRI were performed in 30 patients with VM and 30 healthy controls (HCs). Patients underwent an evaluation of migraine and dizziness severity. FC and voxel-based morphometry (VBM) were performed using DPABI 4.3 and CAT12, respectively. The association between changes in gray matter (GM) volume or FC and clinical parameters was also analyzed.ResultsCompared with HCs, patients with VM demonstrated a reduced GM volume in the bilateral parietoinsular vestibular cortex (PIVC), right middle frontal gyrus, and precuneus. The GM volume of the left PIVC was negatively associated with Dizziness Handicap Inventory score in patients with VM. Taking this region as a seed region, we further observed increased FC between the left primary somatosensory cortex (S1)/inferior parietal lobule (IPL) and the left PIVC in patients with VM.ConclusionFC between regions with a decline in GM volume (the PIVC and S1/IPL) is altered in patients with VM, suggesting that abnormalities in vestibular cortical network could be useful for understanding the underlying mechanisms of VM.

On The Alice In Wonderland Syndrome With A Case Report

Alice in Wonderland syndrome is a rare neurological disorder characterized by transient distorsion of visual perception, impaired perception of one’s own body and time sometimes along with derealization and depersonalization. One of the rare visual symptoms of this syndrome is inversion of visual perception, consisting of rotating or inverting the image of the observed environment lasting several seconds or minutes. The transient inversion of visual perception is thought to be the result of dysfunction of the parieto-insular vestibular or parieto-occipital cortex. We present a 6-year-old boy (М.М.К.) who informed his parents about three episodes of “rotation of the images” in front of him in the last several weeks, lasting 1-2 minutes and abruptly disappearing. Conducted neurological status, neuro-ophthalmological examination, electro-encephalography did not show the presence of abnormalities. MRT of the brain revealed the only pathologic finding – mild unilateral (left) lateral ventricular dilatation due to left foramen of Monro stenosis, interpreted as congenital. We hypothesize that mild unilateral hydrocephalus may be an etiological factor in our patient and cause transient cortical dysfunction and visual-spatial imbalance with impaired verticality.

Neuroimaging studies in persistent postural-perceptual dizziness and related disease: a systematic review.

Persistent Postural-Perceptual Dizziness (PPPD) is one of the most common types of chronic dizziness. The pathogenesis remains unclear. This study aimed to systematically review neuroimaging literature for investigating the central mechanism of PPPD and related disorders. PubMed, EMBASE, Medline, Cochrane,and Web of Science were searched by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles analyzing structural and functional neuroimaging features of PPPD and related disorders were selected according to eligibility criteria. Fifteen articles, including 4 structural, 10 functional, and 1 multimodal imaging, were eligible for inclusion in this review. The whiter matter alterations in PPPD are not entirely consistent. The changes of grey matter mainly in multisensory vestibular cortices, visual cortex, cerebellum, as well as anxiety-related network. Consistent with structural imaging, functional imaging conducted during the specific tasks or in the resting state has both found abnormal functional activation and connectivity in the vestibular cortex, especially in the parieto-insular vestibular cortex (PIVC), visual cortex, cerebellum, and anxiety-related network in PPPD and related disorder. The current review provides up-to-date knowledge and summarizes the possible central mechanism for PPPD and related disorders, and it is helpful to understanding the mechanism of PPPD.

Dynamics of Heading and Choice-Related Signals in the Parieto-Insular Vestibular Cortex of Macaque Monkeys.

Perceptual decision-making is increasingly being understood to involve an interaction between bottom-up sensory-driven signals and top-down choice-driven signals, but how these signals interact to mediate perception is not well understood. The parieto-insular vestibular cortex (PIVC) is an area with prominent vestibular responsiveness, and previous work has shown that inactivating PIVC impairs vestibular heading judgments. To investigate the nature of PIVC's contribution to heading perception, we recorded extracellularly from PIVC neurons in two male rhesus macaques during a heading discrimination task, and compared findings with data from previous studies of dorsal medial superior temporal (MSTd) and ventral intraparietal (VIP) areas using identical stimuli. By computing partial correlations between neural responses, heading, and choice, we find that PIVC activity reflects a dynamically changing combination of sensory and choice signals. In addition, the sensory and choice signals are more balanced in PIVC, in contrast to the sensory dominance in MSTd and choice dominance in VIP. Interestingly, heading and choice signals in PIVC are negatively correlated during the middle portion of the stimulus epoch, reflecting a mismatch in the polarity of heading and choice signals. We anticipate that these results will help unravel the mechanisms of interaction between bottom-up sensory signals and top-down choice signals in perceptual decision-making, leading to more comprehensive models of self-motion perception.SIGNIFICANCE STATEMENT Vestibular information is important for our perception of self-motion, and various cortical regions in primates show vestibular heading selectivity. Inactivation of the macaque vestibular cortex substantially impairs the precision of vestibular heading discrimination, more so than inactivation of other multisensory areas. Here, we record for the first time from the vestibular cortex while monkeys perform a forced-choice heading discrimination task, and we compare results with data collected previously from other multisensory cortical areas. We find that vestibular cortex activity reflects a dynamically changing combination of sensory and choice signals, with both similarities and notable differences with other multisensory areas.

Altered Processing of Complex Visual Stimuli in Patients with Postconcussive Visual Motion Sensitivity.

Vestibular symptoms are common after concussion. Vestibular Ocular Motor Screening identifies vestibular impairment, including postconcussive visual motion sensitivity, though the underlying functional brain alterations are not defined. We hypothesized that alterations in multisensory processing are responsible for postconcussive visual motion sensitivity, are detectable on fMRI, and correlate with symptom severity. Twelve patients with subacute postconcussive visual motion sensitivity and 10 healthy control subjects underwent vestibular testing and a novel fMRI visual-vestibular paradigm including 30-second "neutral" or "provocative" videos. The presence of symptoms/intensity was rated immediately after each video. fMRI group-level analysis was performed for a "provocative-neutral" condition. Z-statistic images were nonparametrically thresholded using clusters determined by Z > 2.3 and a corrected cluster significance threshold of P = .05. Symptoms assessed on Vestibular Ocular Motor Screening were correlated with fMRI mean parameter estimates using Pearson correlation coefficients. Subjects with postconcussive visual motion sensitivity had significantly more Vestibular Ocular Motor Screening abnormalities and increased symptoms while viewing provocative videos. While robust mean activation in the primary and secondary visual areas, the parietal lobe, parietoinsular vestibular cortex, and cingulate gyrus was seen in both groups, selective increased activation was seen in subjects with postconcussive visual motion sensitivity in the primary vestibular/adjacent cortex and inferior frontal gyrus, which are putative multisensory visual-vestibular processing centers. Moderate-to-strong correlations were found between Vestibular Ocular Motor Screening scores and fMRI activation in the left frontal eye field, left middle temporal visual area, and right posterior hippocampus. Increased fMRI brain activation in visual-vestibular multisensory processing regions is selectively seen in patients with postconcussive visual motion sensitivity and is correlated with Vestibular Ocular Motor Screening symptom severity, suggesting that increased visual input weighting into the vestibular network may underlie postconcussive visual motion sensitivity.

Visual Attention Modulates Glutamate-Glutamine Levels in Vestibular Cortex: Evidence from Magnetic Resonance Spectroscopy.

Attending to a stimulus enhances the neuronal responses to it, while responses to nonattended stimuli are not enhanced and may even be suppressed. Although the neural mechanisms of response enhancement for attended stimuli have been intensely studied, the neural mechanisms underlying attentional suppression remain largely unknown. It is uncertain whether attention acts to suppress the processing in sensory cortical areas that would otherwise process the nonattended stimulus or the subcortical input to these cortical areas. Moreover, the neurochemical mechanisms inducing a reduction or suppression of neuronal responses to nonattended stimuli are as yet unknown. Here, we investigated how attention directed toward visual processing cross-modally acts to suppress vestibular responses in the human brain. By using functional magnetic resonance spectroscopy in a group of female and male subjects, we find that attention to visual motion downregulates in a load-dependent manner the concentration of excitatory neurotransmitter (glutamate and its precursor glutamine, referred to together as Glx) within the parietoinsular vestibular cortex (PIVC), a core cortical area of the vestibular system, while leaving the concentration of inhibitory neurotransmitter (GABA) in PIVC unchanged. This makes PIVC less responsive to excitatory thalamic vestibular input, as corroborated by functional magnetic resonance imaging. Together, our results suggest that attention acts to suppress the processing of nonattended sensory cues cortically by neurochemically rendering the core cortical area of the nonattended sensory modality less responsive to excitatory thalamic input.SIGNIFICANCE STATEMENT Here, we address a fundamental problem that has eluded attention research for decades, namely, how the brain ignores irrelevant stimuli. To date, three classes of solutions to this problem have been proposed: (1) enhancement of GABAergic interneuron activity in cortex, (2) downregulation of glutamatergic cell activity in cortex; and (3) downregulation of neural activity in thalamic projection areas, which would then provide the cortex with less input. Here, we use magnetic resonance spectroscopy in humans and find support for the second hypothesis, implying that attention to one sensory modality involves the suppression of irrelevant stimuli of another sensory modality by downregulating glutamate in the cortex.

Post-stroke dizziness of visual-vestibular cortices origin

Many patients with chronic cerebrovascular diseases complain “dizziness”, which is a distortion of static gravitational orientation, or an erroneous perception of motion of the sufferer or of the environment. In the vestibular cortical system, the parieto-insular vestibular cortex (PIVC) serves as the core region having the strong interconnections with other vestibular cortical areas and the vestibular brainstem nuclei. By forming the reciprocal inhibitory interactions with the visual cortex (VISC), it also plays a pivotal role in a multisensory mechanism for self-motion perception. In a line of our studies on post-stroke patients, we found that there was a significant decrease in the cerebral blood flow in both the VISC and PIVC in the patients who suffered from dizziness. In this article, we provide a new concept that due to dysfunction of the visual-vestibular interaction loop, low cerebral blood perfusion in the PIVC and VISC might elicit post-stroke dizziness.

Structural connectome and connectivity lateralization of the multimodal vestibular cortical network

Unlike other sensory systems, the structural connectivity patterns of the human vestibular cortex remain a matter of debate. Based on their functional properties and hypothesized centrality within the vestibular network, the ‘core’ cortical regions of this network are thought to be areas in the posterior peri-sylvian cortex, in particular the retro-insula (previously named the posterior insular cortex-PIC), and the subregion OP2 of the parietal operculum.To study the vestibular network, structural connectivity matrices from n=974 healthy individuals drawn from the public Human Connectome Project (HCP) repository were estimated using multi-shell diffusion-weighted data followed by probabilistic tractography and spherical-deconvolution informed filtering of tractograms in combination with subject-specific grey-matter parcellations. Weighted graph-theoretical measures, modularity, and ‘hubness’ of the multimodal vestibular network were then estimated, and a structural lateralization index was defined in order to assess the difference in fiber density of homonym regions in the right and left hemisphere. Differences in connectivity patterns between OP2 and PIC were also estimated.We found that the bilateral intraparietal sulcus, PIC, and to a lesser degree OP2, are key ‘hub’ regions within the multimodal vestibular network. PIC and OP2 structural connectivity patterns were lateralized to the left hemisphere, while structural connectivity patterns of the posterior peri-sylvian supramarginal and superior temporal gyri were lateralized to the right hemisphere. These lateralization patterns were independent of handedness.We also found that the structural connectivity pattern of PIC is consistent with a key role of PIC in visuo-vestibular processing and that the structural connectivity pattern of OP2 is consistent with integration of mainly vestibular somato-sensory and motor information. These results suggest an analogy between PIC and the simian visual posterior sylvian (VPS) area and OP2 and the simian parieto-insular vestibular cortex (PIVC).Overall, these findings may provide novel insights to the current models of vestibular function, as well as to the understanding of the complexity and lateralized signs of vestibular syndromes.

Spectral fingerprints of correct vestibular discrimination of the intensity of body accelerations

Perceptual decision-making is a complex task that requires multiple processing steps performed by spatially distinct brain regions interacting in order to optimize perception and motor response. Most of our knowledge on these processes and interactions were derived from unimodal stimulations of the visual system which identified the lateral intraparietal area and the posterior parietal cortex as critical regions. Unlike the visual system, the vestibular system has no primary cortical areas and it is associated with separate multisensory areas within the temporo-parietal cortex with the parieto-insular vestibular cortex, PIVC, being the core region. The aim of the presented experiment was to investigate the transition from sensation to perception and to reveal the main structures of the cortical vestibular system involved in perceptual decision-making. Therefore, an EEG analysis was performed in 35 healthy subjects during linear whole-body accelerations of different intensities on a motor-driven motion platform (hexapod). We used a discrimination task in order to judge the intensity of the accelerations. Furthermore, we manipulated the expectation of the upcoming stimulus by indicating the probability (25%, 50%, 75%, 100%) of the motion direction. The analysis of the vestibular evoked potentials (VestEPs) showed that the decision-making process leads to a second positive peak (P2b) which was not observed in previous task-free experiments. The comparison of the estimated neural generators of the P2a and P2b components showed significant activity differences in the anterior cingulus, the parahippocampal and the middle temporal gyri. Taking into account the time courses of the P2 components, the physical properties of the stimuli, and the responses given by the subjects we conclude that the P2b likely reflects the transition from the processing of sensory information to perceptual evaluation. Analyzing the decision-uncertainty reported by the subjects, a persistent divergence of the time courses starting at 188 ​ms after the acceleration was found at electrode Pz. This finding demonstrated that meta-cognition by means of confidence estimation starts in parallel with the decision-making process itself. Further analyses in the time-frequency domain revealed that a correct classification of acceleration intensities correlated with an inter-trial phase clustering at electrode Cz and an inter-site phase clustering of theta oscillations over frontal, central, and parietal cortical areas. The sites where the phase clustering was observed corresponded to core decision-making brain areas known from neuroimaging studies in the visual domain.

Associations between Age-Related Changes in the Core Vestibular Projection Pathway and Balance Ability: A Diffusion Tensor Imaging Study.

Objective We investigated the changes of the vestibulospinal tract (VST) and parietoinsular vestibular cortex (PIVC) using diffusion tensor imaging (DTI) and relation to balance between old and young healthy adults. Methods This study recruited eleven old adults (6 males, 5 females; mean age 63.36 ± 4.25 years) and 12 young adults (7 males, 5 females; mean age 28.42 ± 4.40 years). The lateral and medial VST and PIVC were reconstructed using DTI. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. The six-minute walk test (6-MWT), the timed up and go test (TUG), and the Berg balance scale (BBS) were conducted. Spatiotemporal parameters during tandem gait and values of sway during one-leg standing using the wearable sensors were measured. All parameters between two groups were analyzed by the Mann-Whitney U test and independent t-test. Results Statistically significant decrease in old adults was detected in the tract volume of lateral (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (p = 0.005) and medial VST (Conclusion The results suggested that there was a relationship between DTI parameters in the vestibular neural pathway and balance according to aging.

Attention Networks in the Parietooccipital Cortex Modulate Activity of the Human Vestibular Cortex during Attentive Visual Processing.

Previous studies in human subjects reported that the parieto-insular vestibular cortex (PIVC), a core area of the vestibular cortex, is inhibited when visual processing is prioritized. However, it has remained unclear which networks in the brain modulate this inhibition of PIVC. Based on previous results showing that the inhibition of PIVC is strongly influenced by visual attention, we here examined whether attention networks in the parietooccipital cortex modulate the inhibition of PIVC. Using diffusion-weighted and resting-state fMRI in a group of female and male subjects, we found structural and functional connections between PIVC and the posterior parietal cortex (PPC), a major brain region of the cortical attention network. We then temporarily inhibited PPC by repetitive transcranial magnetic stimulation (rTMS) and hypothesized that the modulatory influence of PPC over PIVC would be reduced; and, as a result, PIVC would be less inhibited. Subjects performed a visual attentional tracking task immediately after rTMS, and the inhibition of PIVC during attentive tracking was measured with fMRI. The results showed that the inhibition of PIVC during attentive tracking was less pronounced compared with sham rTMS. We also examined the effects of inhibitory rTMS over the occipital cortex and found that the visual-vestibular posterior insular cortex area was less activated during attentive tracking compared with sham rTMS or rTMS over PPC. Together, these results suggest that attention networks in the parietooccipital cortex modulate activity in core areas of the vestibular cortex during attentive visual processing.SIGNIFICANCE STATEMENT Although multisensory integration is generally considered beneficial, it can become detrimental when cues from different senses are in conflict. The occurrence of such multisensory conflicts can be minimized by inhibiting core cortical areas of the subordinate sensory system (e.g., vestibular), thus reducing potential conflict with ongoing processing of the prevailing sensory (e.g., visual) cues. However, it has remained unclear which networks in the brain modulate the magnitude of inhibition of the subordinate sensory system. Here, by investigating the inhibition of the vestibular sensory system when visual processing is prioritized, we show that attention networks in the parietooccipital cortex modulate the magnitude of inhibition of the vestibular cortex.

Isolated Dizziness with Subjective Visual Vertical Tilt in Acute Infarction of Temporo-Parieto-Occipital Junction

Pathological tilts of the subjective visual vertical (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 cortex. SVV deviations in cortical lesion are usually related with the parietoinsular vestibular cortex or superior temporal gyrus. We report isolated dizziness with contralesional SVV tilt with a focal infarction restricted to the right temporo-parieto-occipital junction. Key Words: Visual perception, Stroke, Dizziness

Vestibular disorders in roll plane from brainstem to cortex

The aim is 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. The focus is particularly on human psychophysics, neurophysiological and imaging data on vestibular disorders in the roll plane. The signs and symptoms are head tilt, vertical divergence of the eyes (skew deviation), ocular torsion, and tilts of subjective visual vertical (SVV) adjustments, all of which represent the so-called ocular tilt reaction (OTR). Furthermore, these signs will be related to mathematical modeling of specific vestibular cell functions for orientation in space in rodents and in patients. 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 [[1]Brandt T. Dieterich M. The dizzy patient: Don’t forget disorders of the central vestibular system.Nat. Rev. Neurol. 2017 Jun; 13: 352-362https://doi.org/10.1038/nrneurol.2017.58Google Scholar]. 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, i.e. components of OTR, 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. Vestibular function in the roll plane and its disorders can be mathematically modeled by an attractor model of the function of angular head velocity cells and head direction cells [[2]Glasauer S. Dieterich M. Brandt T. Neuronal network-based mathematical modelling of perceived verticality in acute unilateral vestibular lesions: from nerve to thalamus and cortex.J. Neurol. 2018 May 29; https://doi.org/10.1007/s00415-018-8909-5Google Scholar]. 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. Together with additional ocular motor or brainstem signs they allow precise topographical diagnosis of side and level.