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Biomedical subjects

M Dieterich

Publications and source records attributed to M Dieterich.

At least 55 records · Page 3Linked to original sources
PubMed1999

Subjective straight-ahead during neck muscle vibration: effects of ageing.

The subjective visual straight-ahead (SVA) was measured psychophysically before and during unilateral vibration of the posterior neck muscles in order to determine the particular contribution of neck muscle spindles to the perception of body orientation during ageing. We found a symmetrical increase of the vibration-induced displacement of the SVA with advancing age (R = +0.73, p < 0.01, n = 60) in 30 healthy subjects of different ages (range 20-81 years). These data indicate the cervical proprioceptive contribution to multisensory body orientation increases with ageing. One possible interpretation is that the sensorial weight of proprioception increases as the peripheral vestibular input decreases with advancing age, thereby substituting for the lack of vestibular function.

Adult↗
PubMed1999

Simulation of pathological ocular counter-roll and skew-torsion by a 3-D mathematical model.

A basic version of a 3-D mathematical model for simulation of otolithic control of binocular static eye position was extended by introducting excitatory commissural fibers between the vestibular nuclei, and physiological non-linearities: the force-response relationship of utricular neurons and a quadratic relationship between eye muscle innervation and force. These modifications appeared to be necessary in order to simulate the gain asymmetry of ocular counter-roll to lateral head tilt in patients with unilateral utricular loss. The current model can adequately simulate skew-torsion in patients with unilateral utricular loss, lesions of the vestibular nuclei, and central graviceptive pathway lesions. The direction of simulated skew-torsion corresponds satisfactorily to data from normals and patients with acute vestibular loss. The relatively low values of predicted eye deviations for peripheral vestibular lesions suggest that part of the effects seen in patients is caused by affection of the semicircular canals.

Action Potentials↗
PubMed1999

The vestibular cortex. Its locations, functions, and disorders.

Evidence is presented that the multisensory parieto-insular cortex is the human homologue of the parieto-insular vestibular cortex (PIVC) in the monkey and is involved in the perception of verticality and self-motion. Acute lesions (patients with middle cerebral artery infarctions) of this area caused contraversive tilts of perceived vertical, body lateropulsion, and, rarely, rotational vertigo. Brain activation studies using positron emission tomography or functional magnetic resonance tomography showed that PIVC was activated by caloric irrigation of the ears or by galvanic stimulation of the mastoid. This indicates that PIVC receives input from both the semicircular canals and otoliths. PIVC was also activated during small-field optokinetic stimulation, but not when the nystagmus was suppressed by fixation. Activation of vestibular cortex areas, visual motion-sensitive areas, and ocular motor areas exhibited a significant right-hemispheric dominance. The vestibular cortex intimately interacts with the visual cortex to match the two 3-D orientation maps (perception of verticality, room-tilt illusion) and mediates self-motion perception by means of a reciprocal inhibitory visual-vestibular interaction. This mechanism of an inhibitory interaction allows a shift of the dominant sensorial weight during self-motion perception from one sensory modality (visual or vestibular) to the other, depending on which mode of stimulation prevails: body acceleration (vestibular input) or constant velocity motion (visual input).

Animals↗
PubMed1999

Increased body sway at 3.5-8 Hz in patients with phobic postural vertigo.

Postural sway during upright stance was analyzed in 12 patients with phobic postural vertigo (PPV) and in 12 age-matched healthy volunteers. Recordings were made under different conditions (with the eyes open or closed): when standing on a foam rubber pad with the head upright, turned 30 degrees to the right or left, or during 1 Hz horizontal head oscillations. Sway analysis included calculation of sway path, of root mean square values of sway and of the power spectrum of sway in fore/aft and lateral directions. There was a significant increase in sway activity in the 3.53-8 Hz frequency band in patients with PPV. This did not impair objective postural stability. Increase in higher frequency sway activity may simply reflect a change in postural strategy rather than a sensorimotor dysfunction. The patients' conscious control of stance may augment co-activation of anti-gravity muscles, a strategy applied by normal subjects when performing demanding balancing tasks.

Adult↗
PubMed1999

Distribution of herpes simplex virus type 1 in human geniculate and vestibular ganglia: implications for vestibular neuritis.

Vestibular neuritis is a common cause of partial unilateral vestibular paralysis, which usually spares posterior semicircular canal function. The cause is assumed to be a viral reactivation of latent herpes simplex virus type 1 (HSV-1) in human vestibular ganglia. The existence of an anastomosis between the intermediate nerve and the superior vestibular nerve suggests the question of whether selective affliction of the superior vestibular nerve is the result of migration of HSV-1 from the geniculate ganglion along this faciovestibular anastomosis. We determined the distribution of HSV-1 among geniculate ganglia, vestibular ganglia, and within Scarpa's ganglion by examining 35 human temporal bones by polymerase chain reaction. HSV-1 was found in 66% of geniculate ganglia and 60% of vestibular ganglia; all examined parts of vestibular ganglia were almost equally HSV-1 infected. Our data provided no support for viral migration along this anastomosis or for a preferential latency of HSV-1 in the superior vestibular nerve. We suggest that the common double innervation of the posterior ampulla by two nerves running in two separate bony canals could offer an alternative explanation for the regular sparing of posterior canal function in vestibular neuritis.

Adolescent↗
PubMed1999

Episodic vertigo related to migraine (90 cases): vestibular migraine?

A retrospective study was conducted on 90 patients with episodic vertigo that could be related to migraine as the most probable pathomechanism. Since the majority of the patients did not fulfill the criteria of the International Headache Society (IHS) for basilar migraine, the diagnosis was substantiated by disease course, medical efficacy in treating (ergotamines) and preventing (metoprolol, flunarizine) attacks, ocular motor abnormalities in the symptom-free interval, and careful exclusion of the most relevant differential diagnoses, such as transient ischemic attacks, Menière's disease, and vestibular paroxysmia. The following clinical features were elaborated. The initial manifestation could occur at any time throughout life, with a peak in the fourth decade in men and a "plateau" between the third and fifth decades in women. The duration of rotational (78%) and/or to-and-fro vertigo (38%) could last from a few seconds to several hours or, less frequently, even days; duration of a few minutes or of several hours was most frequent. Monosymptomatic audiovestibular attacks (78%) occurred as vertigo associated with auditory symptoms in only 16%. Vertigo was not associated with headache in 32% of the patients. In the symptom-free interval 66% of the patients showed mild central ocular motor signs such as vertical (48%) and/or horizontal (22%) saccadic pursuit, gaze-evoked nystagmus (27%), moderate positional nystagmus (11%), and spontaneous nystagmus (11%). Combinations with other forms of migraine were found in 52%. Thus, migraine is a relevant differential diagnosis for episodic vertigo. According to the criteria of the IHS, only 7.8% of these patients would be diagnosed as having basilar migraine. However, to ensure that at least those presenting with monosymptomatic episodic vertigo (78% in our study) receive effective treatment, we propose the use of the more appropriate term "vestibular migraine."

Adolescent↗
PubMed1999

Sympathetic contralateral vestibulopathy after unilateral zoster oticus.

A unique case of initially right sided varicella zoster induced Ramsay-Hunt syndrome with complete vestibular loss is reported. The patient subsequently developed deficits of the left vestibule 5 months later. An autoimmune pathogenesis of the left vestibular failure rather than bilateral varicella zoster infection was suggested by the following data: (1) no evidence of vesicular eruptions on the left auricle and the virtual absence of antiviral antibodies after onset of bilateral vestibulopathy; (2) prompt response of the left vestibule to immunosuppressive therapy with corticosteroids; and (3) presence of atypical nervous tissue specific autoantibodies against a 45 kDa protein.

Adult↗
PubMed1998

Three-dimensional modeling of static vestibulo-ocular brain stem syndromes.

Static vestibulo-ocular brain stem syndromes characterized by skew deviation, a vertical disconjugacy of the eyes, and ocular torsion are the result of a vestibular tone imbalance in the frontal (roll) plane. Similar physiological changes in static eye position, ocular counter-roll and conjugated deviations of vertical eye position, are caused by the influence of gravity mediated by the utricles. These observations prompted our approach with the model described here: based on the known deviations of static eye position, we devised a three-dimensional mathematical model of otolith-ocular function including detailed brain stem anatomy. This model is able to explain and predict the differential effects of unilateral and bilateral peripheral or central vestibular lesions on static eye position in roll, pitch, and yaw planes.

Animals↗
PubMed1998

Highly variable distribution of HSV-1-specific DNA in human geniculate, vestibular and spiral ganglia.

Viral reactivation in temporal ganglia is the suspected cause of Bell's palsy, vestibular neuritis and sudden hearing loss. Since the distribution of latent herpes simplex type 1 (HSV-1) in geniculate, vestibular and spiral ganglia of individual human temporal bones could have implications for the explanation of isolated as well as combined disorders of these three cranial nerves, we examined these ganglia in 18 human temporal bones of adults by nested polymerase chain reaction. In all of the temporal bones HSV-1 specific DNA was detected: 10/18 (56%) of the geniculate, 11/18 (61%) of the vestibular and 9/18 (50%) of the spiral ganglia samples were positive. All combinations of positive and negative ganglia were found in individual temporal bones at roughly equal frequencies. These data support a viral etiology of all three conditions, especially their occasional combinations.

Adult↗
PubMed1998

Bilateral vestibular failure impairs visual motion perception even with the head still.

Visual motion perception of a single object, moving with a constant angular velocity of 40 min of arc/s in four orthogonal directions, was measured in eight patients with chronic bilateral vestibular failure (BVF) with the head stationary. Perception of object motion was more severely impaired for horizontal than for vertical directions and the impairment was more pronounced in the dominant eye than the nondominant eye. Impaired motion perception in patients with BVF is best explained by a central visual mechanism that suppresses oscillopsia due to the involuntary retinal slip caused by the defective vestibulo-ocular reflex (VOR). This mechanism cannot be switched off with the head stationary (inactive VOR) and thus causes a measurable deficit of motion perception.

Adult↗
PubMed1998

Direction-specific impairment of motion perception and spatial orientation in downbeat and upbeat nystagmus in humans.

Downbeat and upbeat nystagmus can be classified as central vestibular syndromes in the vertical (pitch) plane of the vestibulo-ocular reflex (VOR) which are defined by ocular motor, perceptual, and postural manifestations. While the ocular motor syndrome was often studied investigations on the perceptual consequences for spatial orientation and motion perception are rare. Subjective visual straight ahead (SVA) and perception of object motion were measured in 11 patients with downbeat (n=6) and upbeat (n=5) nystagmus. Upward deviations of SVA (median +5.2 degrees) were found in downbeat nystagmus, and downward deviations (median -7.8 degrees) in upbeat nystagmus. SVA was deviated toward the slow phase of the vertical nystagmus in the pitch plane and associated with increased fore-aft body sway. Perception of object motion was more severely impaired for vertical (particularly for motion in the direction of slow nystagmus phases) than for horizontal directions in both downbeat and upbeat nystagmus. Impairment of motion perception in the vertical pitch plane of the VOR is beneficial to the extent that it alleviates disturbing oscillopsia due to the involuntary retinal slip. Thus, our findings confirm the hypothesis that downbeat and upbeat nystagmus reflect a central tone imbalance of the VOR in the vertical pitch plane with ocular motor, postural, and perceptual manifestations.

Adult↗
PubMed1998

Bilateral functional MRI activation of the basal ganglia and middle temporal/medial superior temporal motion-sensitive areas: optokinetic stimulation in homonymous hemianopia.

OBJECTIVE: To determine to what extent sensorimotor control is achieved for each hemisphere separately or interactively during small-field optokinetic stimulation in patients with complete homonymous hemianopia. DESIGN: Functional and structural neuroimaging using high-resolution magnetic resonance imaging. SETTING: University medical center research facility. PATIENTS: Three patients with complete homonymous hemianopia after acute infarction of the right posterior cerebral artery. MAIN OUTCOME MEASURES: Anatomical location of activated structures during horizontal optokinetic stimulation and T2-weighted anatomical magnetic resonance imaging. RESULTS: Occipitotemporal cortical areas (Brodmann areas 39 and 40) were the only activated cortical structures that showed statistically significant (P<.01) activation on the affected hemisphere. Of the subcortical areas, activation of thalamic nuclei appeared to be missing on the affected side, whereas the basal ganglia (putamen, globus pallidus, and caudate nucleus) were bilaterally activated. CONCLUSIONS: Bilateral activation of the basal ganglia confirms the concept of the basal ganglia-thalamocortical motor loop and of the efference copy of oculomotor pathways from each hemisphere. Our findings suggest 2 possible explanations for the activation of occipitotemporal areas (the human homolog of middle temporal/medial superior temporal areas) on the infarcted hemisphere: involvement of direct extrastriatal visual pathways or interhemispheric callosal connections between right and left middle temporal/medial superior temporal areas.

Aged↗
PubMed1998

Cerebral functional magnetic resonance imaging of vestibular, auditory, and nociceptive areas during galvanic stimulation.

Cerebral activation was investigated with functional magnetic resonance imaging (fMRI) during galvanic stimulation of the mastoid in 6 normal volunteers. Cutaneous stimulation at the neck C4-5 level served as a control. During mastoid stimulation, bilateral vestibular activation occurred in the posterior insula (parietoinsular vestibular cortex, PIVC), the transverse temporal (Heschl's) gyrus, and thalamic pulvinar. The cutaneous pain elicited by galvanic stimulation caused bilateral activity of the medial part of the insula and the anterior median thalamus. Thus, galvanic stimulation at the mastoid level activates cortical areas of three different sensory systems in the insulathalamic region, the vestibular, the auditory, and the nociceptive systems.

Adult↗
PubMed1998

Serum antibodies against membranous labyrinth in patients with "idiopathic" bilateral vestibulopathy.

To investigate the possibility of an autoimmune mechanism in idiopathic bilateral vestibulopathy (IBV), we screened patients' sera for antibodies against inner ear structures. IgG antibodies against membranous labyrinth (ampulla, semicircular canals, saccule and utricle) were detected in 8 of 12 patients by immunofluorescence on rat inner ear cryosections. All but one serum of 22 healthy controls and the sera of 6 patients with known autoimmune disorders showed only background staining. Low-titre anti-nuclear IgM antibodies were present in three control sera and one IBV serum. High-titre anti-nuclear IgM was found in a patient with lupus erythematosus and in one with scleroderma. Anti-nuclear IgM was not organ-specific. No human serum used contained detectable anti-vascular preformed antibodies. Cross-reactivity to sections of liver, kidney, cornea, brain and skeletal muscle was absent. Double-staining for IgG and F-actin, the primary constituent of hair cell cilia, did not show predominant Ig-coating of sensory hair cells. Immunosuppressive therapy in 3 IBV patients did not improve the disorder, probably owing to irreversible loss of sensory and neural structures. These data suggest that the bulk of anti-labyrinthine autoantibodies may be an epiphenomenon, yet a small subgroup of organ-specific autoantibodies may synergize with a cellular response in the development of vestibular lesions.

Autoantibodies↗
PubMed1998

Effects of galvanic vestibular stimulation on otolithic and semicircular canal eye movements and perceived vertical.

OBJECTIVE: The aim of this study was to determine the otolithic and semicircular canal effects of galvanic vestibular stimulation with increasing current strengths on eye movements and the perception of verticality. METHODS: We measured (1) 3-dimensional eye movements, (2) subjective tilt of the peripheral visual field, and (3) subjective tilt of a central vertical line in 12 healthy subjects during galvanic vestibular stimulation. A rectangular, unipolar binaural electric current was applied to each subject's mastoid. RESULTS: Anodal stimulation of the right mastoid led to an ipsiversive tonic ocular torsion of up to 5.4 degrees, to a contralateral tilt of both the peripheral visual field (1-9 degrees), and a central vertical line (0.5-6.2 degrees) increasing in amplitude with increasing current strengths applied. This reflects otolith stimulation. In most subjects, current strengths of 3 mA or more elicited a slight (horizontal-) torsional nystagmus (amplitude 1-2 degrees) that was superimposed on static torsion. This reflects horizontal and vertical semicircular canal stimulation. A correlation was found in the amount of the 3 measured parameters and the strength of the applied current. CONCLUSIONS: Thus, galvanic vestibular stimulation at low current intensities (1-3 mA) preferably excites otolith responses, which increase with increasing current intensity. With higher current intensity above 3 mA, additional semicircular canal responses are elicited in the form of horizontal-rotatory nystagmus superimposed on static torsional deviations. The lack of a vertical deviation and nystagmus can be explained by the counterdirected vertical components of the anterior and posterior semicircular canal.

Adult↗
PubMed1998

Perceptual and oculomotor effects of neck muscle vibration in vestibular neuritis. Ipsilateral somatosensory substitution of vestibular function.

Afferent cervical somatosensory input may substitute for absent vestibular information as part of central vestibular compensation after unilateral peripheral vestibular deficit. In order to determine the particular contribution of neck muscle spindles to the perception of body orientation and to the oculomotor system, we measured (i) the subjective visual straight ahead (SVA) by psychophysical tests and (ii) the changes in eye position by video-nystagmography during unilateral stimulation of the posterior neck muscles by vibration (100 Hz). Twenty-five patients with subacute unilateral vestibular lesion (vestibular neuritis) and 25 controls participated in the study. Vibration elicited a horizontal displacement of SVA towards the side of stimulation in all subjects. Mean displacement (+/- SD) was 3.28 +/- 2.96 degrees for right-side and 3.45 +/- 2.93 degrees for left-side stimulation in controls. Muscle stimulation on the patients' lesion side induced a significantly higher displacement (11.51 +/- 6.63 degrees) than contralateral stimulation (3.04 +/- 2.95 degrees, P < 0.01, paired Student's t test). The mean difference during stimulation between the two sides in the patients was 8.02 +/- 5.52 degrees; in the controls, however, it was only 0.74 +/- 0.47 degree (P < 0.001, Student's t test). This asymmetry increased gradually in patients over a period of weeks, reaching a maximum at days 60-80 and declining thereafter. Videonystagmography revealed that ipsilateral stimulation in patients induced large horizontal eye deviations of up to 25 degrees towards the side of the lesion (9.1 +/- 7.6 degrees, n = 18). Contralateral stimulation induced only small shifts, which were within the range of controls. The correlation coefficient between displacement of the SVA and change in eye position was high (r = 0.94, P < 0.0001), indicating that the shift of SVA is the perceptual correlate of the directional change of gaze in space. This interpretation was supported by two control experiments in which the subject was required to (i) indicate the subjective straight ahead by finger-pointing with the eyes closed and (ii) adjust SVA when looking through horizontally reversing prisms. Vibration of neck muscles caused almost no displacement of the SVA when it was indicated by pointing with the eyes closed, but reversed the direction of the displacement if the subject wore reversing prisms. In summary, our data showed: (i) an increase in muscle spindle input following unilateral vestibular lesion; (ii) this increase is asymmetrical, restricted to the affected side, and gradually builds up over weeks; and (iii) the perceived effects during vibration are secondary to changes in eye position rather than changes in cortical representation of body orientation. This is the first study to demonstrate a unilateral increase in somatosensory weight, which substitutes for missing vestibular input.

Adolescent↗