Man in motion. Historical and clinical aspects of vestibular function. A review.
This is a review of selected aspects of the history of the vestibular system (J. E. Purkyne, E. Mach, A. Crum-Brown) and of our current understanding of vestibular malfunction in clinical vertigo syndromes. Evidence is presented for a preliminary classification of central vestibular brainstem syndromes according to the three major planes of action of the vestibulo-ocular reflex (VOR): (1) disorders of the VOR in the horizontal (yaw) plane (horizontal nystagmus, pseudo 'vestibular neuritis'); (2) disorders of the VOR in the sagittal (pitch) plane (downbeat nystagmus; upbeat nystagmus); (3) disorders of the VOR in the frontal (roll) plane (ocular tilt reaction; lateropulsion). The pathophysiology of peripheral vestibular disorders is discussed: a specific gravity differential between the cupula fluid and the endolymph (buoyancy mechanism) causes vertigo in benign paroxysmal positioning vertigo and positional alcohol nystagmus. Vestibular neuritis is probably a partial unilateral vestibular paralysis due to viral infection of the superior division of the nerve trunk. The common post-traumatic vertigo is explained by otolith dysfunction secondary to dislodged otoconia resulting in unequal loads on the macula beds and a tonus imbalance between the two otoliths.
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Department of Neurology, Klinikum Grosshadern, University of Munich, Germany.
D001927:Brain Diseases / Q000503:physiopathology; D006801:Humans; D009039:Motion Perception / Q000502:physiology*; D009443:Neuritis / Q000503:physiopathology; D012027:Reflex, Vestibulo-Ocular; D013577:Syndrome; D014717:Vertigo / Q000503:physiopathology; D015837:Vestibular Diseases / Q000503:physiopathology*; D014725:Vestibular Nerve / Q000503:physiopathology; D014722:Vestibule, Labyrinth / Q000502:physiology*; D014785:Vision, Ocular