Vestibular agnosia in traumatic brain injury and its link to imbalance

作者：Elena Calzolari, Mariya Chepisheva, Rebecca Smith, Mohammad Mahmud, Peter J. Hellyer, Vassilios Tahtis, Qadeer Arshad, Amy Jolly, Mark H. Wilson, Heiko Rust, David Sharp, Barry M. Seemungal · 发表于：Brain · 年份：2020 · DOI：10.1093/brain/awaa386 · 被引用次数：92 · 研究领域：Vestibular and auditory disorders、Traumatic Brain Injury Research、Hearing, Cochlea, Tinnitus, Genetics

Vestibular dysfunction, causing dizziness and imbalance, is a common yet poorly understood feature in patients with TBI. Damage to the inner ear, nerve, brainstem, cerebellum and cerebral hemispheres may all affect vestibular functioning, hence, a multi-level assessment-from reflex to perception-is required. In a previous report, postural instability was the commonest neurological feature in ambulating acute patients with TBI. During ward assessment, we also frequently observe a loss of vertigo sensation in patients with acute TBI, common inner ear conditions and a related vigorous vestibular-ocular reflex nystagmus, suggesting a 'vestibular agnosia'. Patients with vestibular agnosia were also more unbalanced; however, the link between vestibular agnosia and imbalance was confounded by the presence of inner ear conditions. We investigated the brain mechanisms of imbalance in acute TBI, its link with vestibular agnosia, and potential clinical impact, by prospective laboratory assessment of vestibular function, from reflex to perception, in patients with preserved peripheral vestibular function. Assessment included: vestibular reflex function, vestibular perception by participants' report of their passive yaw rotations in the dark, objective balance via posturography, subjective symptoms via questionnaires, and structural neuroimaging. We prospectively screened 918 acute admissions, assessed 146 and recruited 37. Compared to 37 matched controls, patients showed elevated vestibu...