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Spatial orientation in patients with chronic unilateral vestibular hypofunction is ipsilesionally distorted


Müller, J A; Bockisch, C J; Tarnutzer, A A (2016). Spatial orientation in patients with chronic unilateral vestibular hypofunction is ipsilesionally distorted. Clinical Neurophysiology, 127(10):3243-3251.

Abstract

OBJECTIVE Acute unilateral peripheral-vestibular hypofunction (UVH) shifts the subjective visual vertical (SVV) ipsilesionally, triggering central compensation that usually eliminates shifts when upright. We hypothesized that compensation is worse when roll-tilted. METHODS We quantified SVV errors and variability in different roll-tilted positions (0°, ±45°, ±90°) in patients with chronic UVH affecting the superior branch (SVN; n=4) or the entire (CVN; n=9) vestibular nerve. RESULTS Errors in SVN and CVN were not different. When roll-tilted ipsilesionally 45° (9.6±5.4° vs. -0.2±6.4°, patients vs. controls, p<0.001) and 90° (23.5±5.7° vs. 16.8±8.8°, p=0.003), the patient's SVV was shifted significantly towards the lesioned ear. When upright, only a trend was noted (3.6±2.2° vs. 0.0±1.2°, p=0.099); for contralesional roll-tilts shifts were not different from controls. Variability was larger for CVN than SVN (p=0.046). With increasing disease-duration, adjustment errors decayed for ipsilesional roll-tilt and upright (p⩽0.025). CONCLUSIONS The reason verticality perception was distorted for ipsilesional roll-tilts, may be the insufficient integration of contralesional otolith-input. Similar errors in SVN and CVN suggest a dominant utricular role in verticality perception, albeit the sacculus may improve precision of SVV estimates. SIGNIFICANCE With deficiencies in central compensation being roll-angle dependent, extending SVV-testing to roll-tilted positions may improve identifying patients with chronic UVH.

Abstract

OBJECTIVE Acute unilateral peripheral-vestibular hypofunction (UVH) shifts the subjective visual vertical (SVV) ipsilesionally, triggering central compensation that usually eliminates shifts when upright. We hypothesized that compensation is worse when roll-tilted. METHODS We quantified SVV errors and variability in different roll-tilted positions (0°, ±45°, ±90°) in patients with chronic UVH affecting the superior branch (SVN; n=4) or the entire (CVN; n=9) vestibular nerve. RESULTS Errors in SVN and CVN were not different. When roll-tilted ipsilesionally 45° (9.6±5.4° vs. -0.2±6.4°, patients vs. controls, p<0.001) and 90° (23.5±5.7° vs. 16.8±8.8°, p=0.003), the patient's SVV was shifted significantly towards the lesioned ear. When upright, only a trend was noted (3.6±2.2° vs. 0.0±1.2°, p=0.099); for contralesional roll-tilts shifts were not different from controls. Variability was larger for CVN than SVN (p=0.046). With increasing disease-duration, adjustment errors decayed for ipsilesional roll-tilt and upright (p⩽0.025). CONCLUSIONS The reason verticality perception was distorted for ipsilesional roll-tilts, may be the insufficient integration of contralesional otolith-input. Similar errors in SVN and CVN suggest a dominant utricular role in verticality perception, albeit the sacculus may improve precision of SVV estimates. SIGNIFICANCE With deficiencies in central compensation being roll-angle dependent, extending SVV-testing to roll-tilted positions may improve identifying patients with chronic UVH.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Ophthalmology Clinic
04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Otorhinolaryngology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:October 2016
Deposited On:29 Dec 2016 07:38
Last Modified:29 May 2017 07:42
Publisher:Elsevier
ISSN:1388-2457
Publisher DOI:https://doi.org/10.1016/j.clinph.2016.07.010
PubMed ID:27522490

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