title: Vestibular compensation in acute unilateral medullary infarction: FDG-PET study.
abstract: OBJECTIVE
  The aim of this fluorodeoxyglucose (FDG)-PET study was to determine whether the activation pattern in patients with an acute unilateral central vestibular lesion (e.g., lesion of the vestibular nucleus) differs from that known in patients with an acute peripheral vestibular deficit.
  
  
  METHODS
  Twelve patients with circumscribed unilateral medullary brainstem infarctions (6 right, 6 left) causing acute vestibular imbalance underwent resting-state (18)F-FDG-PET. Regional cerebral glucose metabolism was measured twice without any stimulation and with eyes closed: in the acute phase after infarct onset on mean day 8 (range 4-12), and again 6 months later in 7 patients after recovery. Group subtraction analyses and comparisons with a dataset of 12 age-matched controls were done with Statistic Parametric Mapping.
  
  
  RESULTS
  In the acute stage, the pattern of signal increases differed from that in peripheral vestibular lesions: whereas signals in the infratentorial areas in the contralateral medulla and cerebellum (peduncle, vermis, hemispheres) were increased, areas at the cortical level were largely spared. Signal decreases were found in similar sites in the visual cortex bilaterally.
  
  
  CONCLUSIONS
  The current data provide evidence that the lesion site significantly modifies the glucose metabolism pattern in an acute vestibular lesion. Different compensation strategies seem to be apparent: after vestibular nucleus lesions, compensation occurs preferably in brainstem-cerebellar loops; after peripheral lesions, it occurs at the cortical level.
authors: Department of Neurology, University of Munich, Munich, Germany. sandra.bense@med.unimuenchen.de
authors: Sandra
authors: S
authors: Becker-Bense
authors: Hans-Georg
authors: HG
authors: Buchholz
authors: Christoph
authors: C
authors: Best
authors: Mathias
authors: M
authors: Schreckenberger
authors: Peter
authors: P
authors: Bartenstein
authors: Marianne
authors: M
authors: Dieterich
mesh_terms: D000222:Adaptation, Physiological / Q000502:physiology*; D000368:Aged; D020526:Brain Stem Infarctions / Q000000981:diagnostic imaging* / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D005947:Glucose / Q000378:metabolism; D006801:Humans; D008297:Male; D008526:Medulla Oblongata / Q000000981:diagnostic imaging* / Q000378:metabolism; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D014722:Vestibule, Labyrinth / Q000000981:diagnostic imaging* / Q000378:metabolism
chemical_list: D019788:Fluorodeoxyglucose F18; D005947:Glucose