RT Journal Article
SR Electronic
T1 Vestibular compensation in acute unilateral medullary infarction
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1103
OP 1109
DO 10.1212/WNL.0b013e31828868a6
VO 80
IS 12
A1 Becker-Bense, Sandra
A1 Buchholz, Hans-Georg
A1 Best, Christoph
A1 Schreckenberger, Mathias
A1 Bartenstein, Peter
A1 Dieterich, Marianne
YR 2013
UL http://n.neurology.org/content/80/12/1103.abstract
AB Objective: The aim of this fluorodeoxyglucose (FDG)-PET study was to determine whether the activation pattern in patients with an acute unilateral central vestibular lesion (e.g., lesion of the vestibular nucleus) differs from that known in patients with an acute peripheral vestibular deficit.Methods: Twelve patients with circumscribed unilateral medullary brainstem infarctions (6 right, 6 left) causing acute vestibular imbalance underwent resting-state 18F-FDG-PET. Regional cerebral glucose metabolism was measured twice without any stimulation and with eyes closed: in the acute phase after infarct onset on mean day 8 (range 4–12), and again 6 months later in 7 patients after recovery. Group subtraction analyses and comparisons with a dataset of 12 age-matched controls were done with Statistic Parametric Mapping.Results: In the acute stage, the pattern of signal increases differed from that in peripheral vestibular lesions: whereas signals in the infratentorial areas in the contralateral medulla and cerebellum (peduncle, vermis, hemispheres) were increased, areas at the cortical level were largely spared. Signal decreases were found in similar sites in the visual cortex bilaterally.Conclusions: The current data provide evidence that the lesion site significantly modifies the glucose metabolism pattern in an acute vestibular lesion. Different compensation strategies seem to be apparent: after vestibular nucleus lesions, compensation occurs preferably in brainstem-cerebellar loops; after peripheral lesions, it occurs at the cortical level.BA=Brodmann area; FDG=fluorodeoxyglucose; MT=middle temporal; PIVC=parieto-insular vestibular cortex; rCGM=regional cerebral glucose metabolism; SVV=subjective visual vertical