Different time course of compensation of subjective visual vertical and ocular torsion after acute unilateral vestibular lesion

Faralli, Mario; Ricci, Giampietro; Manzari, Leonardo; Zambonini, Giulia; Lapenna, Ruggero; Pettorossi, Vito Enrico

doi:10.1007/s00405-020-06312-0

Cited by 11 publications

(11 citation statements)

References 41 publications

(58 reference statements)

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“…The involvement of the vestibular system in the perception of the vertical has also been revealed by clinical tests (for review Brandt and Dieterich, 1994 ). When the injury occurs at the peripheral level, the subjective perception of verticality is deflected ipsilesionally (Friedmann, 1970 ; Böhmer and Mast, 1999 ; Vibert and Häusler, 2000 ; Lopez et al, 2007 ; Faralli et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Representation of Body Orientation in Vestibular-Defective Patients Before and After Unilateral Vestibular Loss

Borel

Honoré

Bachelard-Serra

et al. 2021

Front. Syst. Neurosci.

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Introduction: The unilateral vestibular syndrome results in postural, oculomotor, perceptive, and cognitive symptoms. This study was designed to investigate the role of vestibular signals in body orientation representation, which remains poorly considered in vestibular patients.Methods: The subjective straight ahead (SSA) was investigated using a method disentangling translation and rotation components of error. Participants were required to align a rod with their body midline in the horizontal plane. Patients with right vestibular neurotomy (RVN; n =8) or left vestibular neurotomy (LVN; n = 13) or vestibular schwannoma resection were compared with 12 healthy controls. Patients were tested the day before surgery and during the recovery period, 7 days and 2 months after the surgery.Results: Before and after unilateral vestibular neurotomy, i.e., in the chronic phases, patients showed a rightward translation bias of their SSA, without rotation bias, whatever the side of the vestibular loss. However, the data show that the lower the translation error before neurotomy, the greater its increase 2 months after a total unilateral vestibular loss, therefore leading to a rightward translation of similar amplitude in the two groups of patients. In the early phase after surgery, SSA moved toward the operated side both in translation and in rotation, as typically found for biases occurring after unilateral vestibular loss, such as the subjective visual vertical (SVV) bias.Discussion and Conclusion: This study gives the first description of the immediate consequences and of the recovery time course of body orientation representation after a complete unilateral vestibular loss. The overall evolution differed according to the side of the lesion with more extensive changes over time before and after left vestibular loss. It is noteworthy that representational disturbances of self-orientation were highly unusual in the chronic stage after vestibular loss and similar to those reported after hemispheric lesions causing spatial neglect, while classical ipsilesional biases were reported in the acute stage. This study strongly supports the notion that the vestibular system plays a major role in body representation processes and more broadly in spatial cognition. From a clinical point of view, SSA appeared to be a reliable indicator for the presence of a vestibular disorder.

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Section: Introductionmentioning

confidence: 99%

Representation of Body Orientation in Vestibular-Defective Patients Before and After Unilateral Vestibular Loss

Borel

Honoré

Bachelard-Serra

et al. 2021

Front. Syst. Neurosci.

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“…The OTR test includes head tilt (HT), skew deviation (SD), ocular torsion (OT), and subjective visual vertical (SVV) tilt. In previous studies, the rates of abnormal HT, SD, abnormal OT, and abnormal SVV in patients with acute peripheral vestibular syndrome were 4-20%, 14-29%, 19-82%, and 50.6-94% (7)(8)(9)(10)(11), respectively. The rates of abnormal HT, SD, abnormal OT, and abnormal SVV in ACVV patients were 3-38%, 29-31%, 57-83%, and 74.1-94% (12)(13)(14), respectively.…”

Section: Introductionmentioning

confidence: 88%

The diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical (±45°) in patients with acute central vascular vertigo

Feng

Zhao

et al. 2022

Front. Neurol.

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ObjectivesTo investigate the localization diagnostic value of the ocular tilt reaction (OTR) plus head tilt subjective visual vertical (SVV) in patients with acute central vascular vertigo (ACVV).MethodsWe enrolled 40 patients with acute infarction, 20 with unilateral brainstem infarction (BI) and 20 with unilateral cerebellar infarction (CI). We also included 20 patients with unilateral peripheral vestibular disorders (UPVD) as the control group. The participants completed the OTR and SVV during head tilt (±45°) within 1 week of symptom onset.ResultsIn patients with ACVV, including that caused by lateral medullary infarction (100%, 2/2), partial pontine infarction (21%, 3/14), and cerebellum infarction (35%, 7/20), we observed ipsiversive OTR, similar to that seen in UPVD patients (80.0%, 16/20). Some of the patients with medial medullary infarction (50%, 1/2), partial pons infarction (42%, 6/14), midbrain infarction (100%, 2/2), and partial cerebellum infarction (30.0%, 6/20) showed contraversive OTR. The skew deviation (SD) of the BI group with ACVV was significantly greater than that of the UPVD group (6.60 ± 2.70° vs. 1.80 ± 1.30°, Z = −2.50, P = 0.012), such that the mean SD of the patients with a pons infarction was 9.50° and that of patients with medulla infarction was 5.00°. In ACVV patients with no cerebellar damage, the area under the curve of the receiver operating characteristic curve corresponding to the use of SD to predict brainstem damage was 0.92 (95%CI: 0.73–1.00), with a sensitivity of 100% and a specificity of 80% when SD ≥ 3°. We found no statistical difference in SD between the UPVD and CI groups (1.33 ± 0.58° vs. 1.80 ± 1.30°, Z = −0.344, P = 0.73). Compared with the UPVD patients, the ACVV patients with a partial pons infarction (43%, 6/14, χ2 = 13.68, P = 0.002) or medulla infarction (25%, 1/4, χ2 = 4.94, P = 0.103) exhibited signs of the ipsiversive E-effect with the contraversive A-effect, while those with a partial medulla infarction (50%, 2/4), pons infarction (43%, 6/14), or cerebellar infarction (60%, 12/20) exhibited a pathological symmetrical increase in the E-effect.ConclusionsThe evaluation of OTR plus head tilt SVV (±45°) in vertigo patients is helpful for identifying and diagnosing ACVV, especially when SD is ≥ 3° or the E-effect is symmetrically increased.

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“…16 However, the deviation of the subjective visual vertical from the vertical line is a clinical sign of static vestibular disfunction. 17 Ipsilesional deviation of the subjective visual vertical indicates damage within the peripheral vestibular system, 18 and contralateral deviation can be a sign of damage to the central vestibular system. 19 Our hypothesis is that studying the two functions in a sample of patients suffering from unilateral vestibular neuritis in the acute phase (less than 72 hours from onset) and some days after the onset of symptoms using ocular vestibularevoked myogenic potentials and subjective visual vertical could give different results.…”

Section: Introductionmentioning

confidence: 99%

The clinical course of vestibular neuritis from the point of view of the ocular vestibular evoked myogenic potential

Manzari¹,

Domenico²,

Zambonini

et al. 2022

J. Laryngol. Otol.

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Background Studying otolith functions after unilateral vestibular neuritis using ocular vestibular-evoked myogenic potentials and subjective visual vertical tests could give different results. Method A total of 39 patients underwent a vestibular assessment that included the Dizziness Handicap Inventory and horizontal and vertical semicircular canal function testing with video head impulse testing, ocular vestibular-evoked myogenic potential testing, cervical vestibular-evoked myogenic potentials and subjective visual vertical testing. Results All patients showed a significant alteration (asymmetry ratio more than 40 per cent) for ocular vestibular-evoked myogenic potentials as well as for subjective visual vertical testing (more than −2° to more than +2°) during the acute phase, whereas after 72 hours from the acute vertigo attack normal values (asymmetry ratio less than 40 per cent) were found in 6 out of 39 patients for ocular vestibular-evoked myogenic potentials and 36 out of 39 for the subjective visual vertical (less than −2° to less than +2°). Conclusion Ocular vestibular-evoked myogenic potentials are the most suitable test to evaluate otolith functions in patients with unilateral vestibular neuritis in the acute and sub-acute phase.

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Different time course of compensation of subjective visual vertical and ocular torsion after acute unilateral vestibular lesion

Cited by 11 publications

References 41 publications

Representation of Body Orientation in Vestibular-Defective Patients Before and After Unilateral Vestibular Loss

Representation of Body Orientation in Vestibular-Defective Patients Before and After Unilateral Vestibular Loss

The diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical (±45°) in patients with acute central vascular vertigo

The clinical course of vestibular neuritis from the point of view of the ocular vestibular evoked myogenic potential

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