Why acute unilateral vestibular cortex lesions mostly manifest without vertigo.

Abstract:

OBJECTIVES:The aim of the current study was, first, to determine the critical causative vestibular areas that in exceptional cases manifest with transient vertigo or dizziness in acute strokes of the middle cerebral artery, and second, to try to explain why in most cases unilateral lesions of these areas manifest without vertigo. METHODS:We determined the ischemic areas of the 10 published cases by overlapping the CT/MRI lesions and attributed them to the temporoparietal vestibular network. RESULTS:These overlap areas were located either in the posterior retroinsular cortex (n = 8), i.e., the parieto-insular vestibular cortex, or the separate parietal vestibular cortex (n = 2). CONCLUSION:Thus, rare vestibular cortical vertigo is mostly elicited by acute lesions of the core region of the retroinsular vestibular network. However, the more interesting question is related to the lack of cortical vertigo when this area is affected. We propose a concept to explain how the unaffected opposite hemisphere can suppress vertigo. This is based on visual-vestibular interaction for motion perception and orientation. It is the hemisphere in which vestibular and visual inputs are in agreement, which is the more reliable and determines the global perception of body orientation and motion.

journal_name

Neurology

journal_title

Neurology

authors

Dieterich M,Brandt T

doi

10.1212/WNL.0000000000001501

subject

Has Abstract

pub_date

2015-04-21 00:00:00

pages

1680-4

issue

16

eissn

0028-3878

issn

1526-632X

pii

WNL.0000000000001501

journal_volume

84

pub_type

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