Central vestibular disorder due to ischemic injury on the parieto-insular vestibular cortex in patients with middle cerebral artery territory infarction

Abstract

Central vestibular disorder is common after middle cerebral artery (MCA) territory infarction. The MCA supplies blood to the parieto-insular vestibular cortex (PIVC), a core region of central vestibular symptoms. We report on patients that sustained injuries of the core vestibular pathway to the PIVC with central vestibular disorder following MCA territory infarction, demonstrated on diffusion tensor imaging (DTI). Nineteen patients with MCA territory infarction and 12 control subjects were recruited. To reconstruct the core vestibular pathway to the PIVC, we defined seed region of interest (ROI) as vestibular nuclei of pons and target ROI as the PIVC. Fractional anisotropy (FA), mean diffusivity, and tract volume were measured. In the affected hemisphere, FA value of the core vestibular pathway to the PIVC revealed significant difference between all patient groups and the control group (P < .05). In contrast, patients with symptoms of ataxia only revealed significant decrement of tract volume compared with the control group (P < .05). Additionally, subgroup B revealed significant decrement of tract volume compared with that of subgroup A and the control group (P < .05). In the unaffected hemisphere, there was no significant difference in all DTI parameters between all patient groups and the control group (P < .05). Injury to the core vestibular pathway to the PIVC was demonstrated in patients that revealed typical central vestibular disorder following MCA territory infarction. Analysis of the core vestibular pathway to the PIVC using DTI would be beneficial in clinical evaluation and management of patients with MCA territory infarction.

Relationship between Dizziness and the Core Vestibular Projection Injury in Patients with Mild Traumatic Brain Injury

“…One analyzer (Kwon HG) performed fiber tracking using probabilistic tractography, which was applied in the default tractography option (5000 streamline samples, 0.5 mm step lengths, curvature thresholds = 0.2) of the Oxford Centre for FMRIB Software Library [35,36]. The CVP was reconstructed from a seed region of interest at the VN corresponding to Schwalbe's and Deiters' nuclei at the pons level [31]. The target region of interest was positioned at the PIVC [31].…”

“…The CVP was reconstructed from a seed region of interest at the VN corresponding to Schwalbe's and Deiters' nuclei at the pons level [31]. The target region of interest was positioned at the PIVC [31]. The core vestibular projection passes from the vestibular nuclei at the level of the pons to the PIVC via the posterolateral thalamus [9].…”

“…Recent studies demonstrated that targeting acuapoin-4 using trifluoperazine was a viable treatment for edema [29,30]. Some studies have reported that a CVP injury is associated with dizziness after ischemic and hemorrhagic stroke using DTT [31][32][33]. However, there are no reports of DTT studies on dizziness caused by an injury to the CVP in patients with mild TBI.…”

Diagnosis of Dizziness Due to a Core Vestibular Projection Injury in a Patient with Intracerebral Hemorrhage

“…For an imaging-based reconstruction of the core vestibular projection, the seed region of interest was placed on the vestibular nuclei that corresponded to Schwalbe's and Deiters' nuclei at the pons level [2][3][4]. The target region of interest was positioned at the parieto-insular vestibular cortex (PIVC) [2][3][4]. The core vestibular projection passes from the vestibular nuclei at the level of the pons to the PIVC via the posterolateral thalamus [2].…”

“…Two studies using DTT have reported on core vestibular projection injuries following a cerebral infarct [4,13]. In 2017, Yeo et al demonstrated that core vestibular projection injuries were associated with central vestibular disorders in 19 patients with middle cerebral artery territory infarctions [4].…”