Objective evaluation of vertigo treatment by functional brain imaging

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The purpose of this study was to evaluate subjective sensation of vertigo by measuring brain activation by vestibular and optokinetic stimulation. The analysis of functional images was performed by Statistical Parametric Mapping (SPM). In normal subjects without neurological disorders, cold air irrigation in the right ear induced vertiginous sensation, and significant activation was observed in the left insula, left inferior parietal lobule (BA40), left inferior occipital gyrus (BA19/37 ; V5), right precuneus (BA7), right supplementary motor area (BA6 ; SMA), right precentral gyrus (BA11) and left cerebellar hemisphere. Small field leftward optokinetic stimulation in normal subjects activated the left primary visual cortex (BA17 ; V1), bilateral middle occipital gyms (BA19 ; V5), bilateral precuneus (BA7), left precentral gyrus (BA4) and left hippocampus. Perception of vertiginous sensation may be processed in the cortical networks involving the insula, inferior parietal lobule and SMA, while V5 and precuneus may be related to eye movements that are common to vestibular and optokinetic systems. Optokinetic stimulation in a patient with vertigo, on the other hand, significantly activated the left V1, left kingual gyrus (BA18/19 ; V5), left SMA, left precentral gyrus (BA4), right insula / inferior frontal gyms, right inferior parietal lobule (BA40), left caudate nucleus and left middle temporal gyrus (BA21), among which vestibular cortices, SMA and basal ganglia were not included in areas activated in normal subjects with identical stimulation. These results suggest that the insula and the inferior parietal lobule may play essential roles in the cortical processing of vertiginous sensation, which may be used for objective evaluation of vertigo and its treatment efficacy.