title: A pathway in the brainstem for roll-tilt of the subjective visual vertical: evidence from a lesion-behavior mapping study.
abstract: The perceived subjective visual vertical (SVV) is an important sign of a vestibular otolith tone imbalance in the roll plane. Previous studies suggested that unilateral pontomedullary brainstem lesions cause ipsiversive roll-tilt of SVV, whereas pontomesencephalic lesions cause contraversive roll-tilts of SVV. However, previous data were of limited quality and lacked a statistical approach. We therefore tested roll-tilt of the SVV in 79 human patients with acute unilateral brainstem lesions due to stroke by applying modern statistical lesion-behavior mapping analysis. Roll-tilt of the SVV was verified to be a brainstem sign, and for the first time it was confirmed statistically that lesions of the medial longitudinal fasciculus (MLF) and the medial vestibular nucleus are associated with ipsiversive tilt of the SVV, whereas contraversive tilts are associated with lesions affecting the rostral interstitial nucleus of the MLF, the superior cerebellar peduncle, the oculomotor nucleus, and the interstitial nucleus of Cajal. Thus, these structures constitute the anatomical pathway in the brainstem for verticality perception. Present data indicate that graviceptive otolith signals present a predominant role in the multisensory system of verticality perception.
authors.affiliation: Department of Neurology, University of Mainz, 55131 Mainz, Germany. baierb@uni-mainz.de
authors.forename: Bernhard
authors.initials: B
authors.lastname: Baier
authors.forename: Frank
authors.initials: F
authors.lastname: Thömke
authors.forename: Janine
authors.initials: J
authors.lastname: Wilting
authors.forename: Caroline
authors.initials: C
authors.lastname: Heinze
authors.forename: Christian
authors.initials: C
authors.lastname: Geber
authors.forename: Marianne
authors.initials: M
authors.lastname: Dieterich
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001931:Brain Mapping; D020526:Brain Stem Infarctions / Q000150:complications* / Q000473:pathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000209:etiology*; D010468:Perceptual Disorders / Q000209:etiology*; D013028:Space Perception / Q000502:physiology*; D014796:Visual Perception / Q000502:physiology*