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Impaired Modulation of the Otolithic Function in Acute Unilateral Cerebellar Infarction

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Abstract

To define the cerebellar contribution in modulating the otolithic signals, we investigated the otolithic function in 27 patients with acute unilateral cerebellar infarctions in the territory of the posterior inferior cerebellar artery (PICA, n = 17, 63 %), combined PICA and superior cerebellar artery (SCA) (n = 7, 30 %), SCA (n = 2, 7 %), and anterior inferior cerebellar artery (n = 1, 4 %) from 2010 to 2012. The patients had evaluation of the ocular tilt reaction [head tilt, ocular torsion (OT), and skew deviation], tilt of the subjective visual vertical (SVV), cervical vestibular evoked myogenic potentials (VEMPs) in response to air conducted tone bursts, and ocular VEMPs induced by tapping the head at AFz. The evaluation was completed within 2 weeks after symptom onset. Patients often showed OT or SVV tilt (15/27, 55.6 %) that was either ipsi- (n = 6) or contraversive (n = 9). Overall, there were no differences in the amplitudes and latencies of cervical and ocular VEMPs between the ipsi- and contralesional sides. However, individual analyses revealed frequent abnormalities of cervical (11/27, 41 %) and/or ocular (9/27, 33 %) VEMPs. While 11 (73 %) of the 15 patients with the OTR/SVV tilt showed abnormalities of cervical (n = 9) and/or ocular (n = 7) VEMP responses, only three (25 %) of the 12 patients without the OTR/SVV tilt had abnormal cervical (n = 2) and/or ocular (n = 2) VEMPs (73 % vs. 25 %, Fisher’s exact test, p = 0.021). The concordance rate in the results of cervical and ocular VEMPs was marginally significant (19/27, 70 %, p = 0.052, binominal). Unilateral cerebellar lesions may generate otolithic imbalances, as evidenced by the OTR/SVV tilt and asymmetric ocular or cervical VEMP responses, but without directionality according to the lesion side. Patients with the OTR/SVV tilt had abnormal VEMPs more often than those without.

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Acknowledgments

The authors thank to Jong Hee Lee for conducting the experiments.

Study funding

This study was supported by grants from the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea (A080750), Seoul National University R&DB Foundation and Small & Medium Business Administration (0420-2009-000), and Korea Medical Device Industrial Cooperative Association and Small & Medium Business Administration (08-2011-065).

Disclosures

Dr. Choi, Dr. Lee, and Ms. HJ Kim report no disclosures.

Dr. JS Kim serves as an Associate Editor of Frontiers in Neuro-otology and on the Editorial Boards of the Journal of Korean Society of Clinical Neurophysiology, Research in Vestibular Science, Journal of Clinical Neurology, Frontiers in Neuro-ophthalmology, Journal of Neuro-ophthalmology, and Case Reports in Ophthalmological Medicine and received research support from SK Chemicals, Co. Ltd.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, South Korea

    Seo Young Choi

  2. Department of Neurology, Chonnam National University Hospital, Chonnam National University College of Medicine, Gwangju, South Korea

    Seung-Han Lee

  3. Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, South Korea

    Hyo Jung Kim & Ji-Soo Kim

  4. Department of Neurology, College of Medicine, Seoul National University, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea

    Ji-Soo Kim

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  1. Seo Young Choi
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Correspondence to Ji-Soo Kim.

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Choi, S.Y., Lee, SH., Kim, H.J. et al. Impaired Modulation of the Otolithic Function in Acute Unilateral Cerebellar Infarction. Cerebellum 13, 362–371 (2014). https://doi.org/10.1007/s12311-013-0544-1

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