A vertigo network derived from human brain lesions and brain stimulation.

Area of Science:

• Neuroscience
• Neurology
• Neuroanatomy

Background:

• Vertigo is a prevalent neurological symptom impacting quality of life.
• While peripheral and subtentorial causes are known, cortical lesions are also implicated in vertigo.
• Understanding the neuroanatomy of cortical vertigo is crucial for diagnosis and treatment.

Purpose of the Study:

• To investigate supratentorial (cortical) lesion locations associated with vertigo.
• To determine if these lesions map to a common functional brain network.
• To validate this network using direct brain stimulation data.

Main Methods:

• Systematic literature review identifying 23 cases of supratentorial lesions linked to vertigo.
• Lesion mapping to a human brain template and functional connectivity analysis using the human connectome (n=1000).
• Validation using stereo-electroencephalography (n=17 patients) to assess stimulation sites.

Main Results:

• Functional connectivity between lesion sites and the bilateral ventral posterior insula was highly sensitive and specific for vertigo.
• A lesion-based vertigo network was defined, including insula, somatosensory cortex, visual areas, thalamus, and cerebellum.
• Direct electrical stimulation of sites within this network elicited vertigo, confirming its role.

Conclusions:

• Cortical lesions and direct electrical stimulation sites causing vertigo converge onto a common brain network.
• The bilateral ventral posterior insula serves as a critical hub within this network.
• This study provides insights into the causal neuroanatomical substrate of vertigo originating from cortical structures.