German Center for Vertigo and Balance Disorders, University of Grosshadern Munich Munich, Germany ; Clinical Neurosciences, University of Grosshadern Munich Munich, Germany.
German Center for Vertigo and Balance Disorders, University of Grosshadern Munich Munich, Germany ; Department of Neurology, University of Munich Munich, Germany.
Front Integr Neurosci. 2014 Jun 2;8:47. doi: 10.3389/fnint.2014.00047. eCollection 2014.
Vestibular disorders are commonly characterized by a combination of perceptual, ocular motor, postural, and vegetative manifestations, which cause the symptoms of vertigo, nystagmus, ataxia, and nausea. Multisensory convergence and numerous polysynaptic pathways link the bilaterally organized central vestibular network with limbic, hippocampal, cerebellar, and non-vestibular cortex structures to mediate "higher" cognitive functions. Anatomical classification of vestibular disorders: The traditional classification of vestibular disorders is based on the anatomical site of the lesion. While it distinguishes between the peripheral and the central vestibular systems, certain weaknesses become apparent when applied clinically. There are two reasons for this: first, peripheral and central vestibular disorders cannot always be separated by the clinical syndrome; second, a third category, namely disorders of "higher vestibular function", is missing. These disorders may be caused by peripheral as well as central vestibular lesions. Functional classification: Here we discuss a new concept of disorders of higher vestibular function which involve cognition and more than one sensory modality. Three conditions are described that exemplify such higher disorders: room tilt illusion, spatial hemineglect, and bilateral vestibulopathy all of which present with deficits of orientation and spatial memory.
Further elaboration of such disorders of higher multisensory functions with respect to lesion site and symptomatology is desirable. The room tilt illusion and spatial hemineglect involve vestibular and visual function to the extent that both conditions can be classified as either disorders of higher vestibular or of higher visual functions. A possible way of separating these disorders in a first step is to determine whether the causative lesion site affects the vestibular or the visual system. For the vestibular system this lesion site may be peripheral or central. The criterion of "higher function" is fulfilled if cognition or senses other than the primarily affected one come into play.
前庭障碍通常表现为感知、眼球运动、姿势和植物性表现的综合，这些表现导致眩晕、眼震、共济失调和恶心等症状。双侧组织的中枢前庭网络与边缘、海马、小脑和非前庭皮质结构的多感觉融合以及众多多突触通路相连接，以介导“更高”的认知功能。前庭障碍的解剖分类：前庭障碍的传统分类基于病变的解剖部位。虽然它区分了外周和中枢前庭系统，但在临床应用中会出现某些弱点。原因有二：首先，外周和中枢前庭障碍不能总是通过临床综合征来区分；其次，缺失了第三类，即“更高前庭功能”障碍。这些障碍可能由外周和中枢前庭病变引起。功能分类：在这里，我们讨论了一种涉及认知和多种感觉模式的更高前庭功能障碍的新概念。描述了三种情况，这些情况说明了更高的障碍：房间倾斜错觉、空间忽略和双侧前庭病变，所有这些都表现出定向和空间记忆的缺陷。
希望进一步阐述与病变部位和症状学相关的更高多感觉功能障碍。房间倾斜错觉和空间忽略涉及前庭和视觉功能，以至于这两种情况都可以归类为更高的前庭或更高的视觉功能障碍。在第一步中，一种可能的分离这些障碍的方法是确定引起病变的部位是否影响前庭系统或视觉系统。对于前庭系统，该病变部位可能是外周或中枢。如果认知或除主要受影响的感觉以外的其他感觉参与其中，则满足“更高功能”标准。
