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Global multisensory reorganization after vestibular brain stem stroke
Julian Conrad1,2, Maximilian Habs1,2, Rainer Boegle1,3
1Department of Neurology, University Hospital, LMU Munich, Munich, Germany.
Annals of Clinical and Translational Neurology
|August 29, 2020
Summary
Brain stem infarcts cause vestibular syndrome. Neuroplasticity in multisensory cortical areas aids recovery, with right-hemispheric specialization for vestibular processing.
Area of Science:
- Neuroscience
- Neuroimaging
- Vestibular System
Background:
- Acute central vestibular syndrome (CVS) presents with vertigo, nystagmus, and postural instability.
- Symptom compensation typically occurs within months, but underlying mechanisms remain unclear.
- Vestibular infarcts are a common cause of CVS, necessitating research into recovery processes.
Purpose of the Study:
- To investigate structural brain changes associated with clinical compensation in patients with unilateral brain stem infarcts.
- To identify gray and white matter volume alterations during vestibular function recovery.
- To explore the relationship between infarct location, vestibular percept quality, and neuroplasticity.
Main Methods:
- Prospective study of patients with acute unilateral brain stem infarcts over six months.
- Voxel-based morphometry (VBM) used to compare structural changes between acute and follow-up phases.
- Comparison with a control group of healthy individuals.
Main Results:
- Vestibular function recovery was linked to downstream structural changes in multisensory cortical areas.
- Changes varied based on infarct location and vestibular percept type (rotatory vs. graviceptive).
- Patients with pontomedullary infarcts showed volumetric increases in specific multisensory areas, often with right-sided preference.
Conclusions:
- Multisensory neuroplasticity in both hemispheres accompanies clinical compensation of vestibular deficits.
- Evidence supports right-hemispheric specialization for core vestibular processing.
- Identified cortical structures offer potential targets for novel rehabilitative treatments, such as transcranial stimulation.
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