Global multisensory reorganization after vestibular brain stem stroke.

Autor: Conrad J; Department of Neurology, University Hospital, LMU Munich, Munich, Germany.; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany., Habs M; Department of Neurology, University Hospital, LMU Munich, Munich, Germany.; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany., Boegle R; Department of Neurology, University Hospital, LMU Munich, Munich, Germany.; Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Munich, Germany., Ertl M; Department of Neurology, University Hospital, LMU Munich, Munich, Germany.; Department of Psychology, University of Bern, Bern, Switzerland., Kirsch V; Department of Neurology, University Hospital, LMU Munich, Munich, Germany.; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany.; Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Munich, Germany., Stefanova-Brostek I; Department of Neurology, Muenchen Klinik, Harlaching, Germany., Eren O; Department of Neurology, University Hospital, LMU Munich, Munich, Germany., Becker-Bense S; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany., Stephan T; Department of Neurology, University Hospital, LMU Munich, Munich, Germany., Wollenweber F; Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.; Department of Neurology, Helios Dr. Horst Schmidt Kliniken, Wiesbaden, Germany., Duering M; Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany.; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany., Zu Eulenburg P; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany.; Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Munich, Germany.; Institute for Neuroradiology, University Hospital, LMU Munich, Munich, Germany., Dieterich M; Department of Neurology, University Hospital, LMU Munich, Munich, Germany.; German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, LMU Munich, Munich, Germany.; Graduate School of Systemic Neurosciences - GSN-LMU, LMU Munich, Munich, Germany.; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
Jazyk: angličtina
Zdroj: Annals of clinical and translational neurology [Ann Clin Transl Neurol] 2020 Oct; Vol. 7 (10), pp. 1788-1801. Date of Electronic Publication: 2020 Aug 28.
DOI: 10.1002/acn3.51161
Abstrakt: 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.
(© 2020 The Authors. Annals of Clinical and Translational Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.)
Databáze: MEDLINE
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