Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, 200062, China.
Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
Cerebellum. 2021 Oct;20(5):804-809. doi: 10.1007/s12311-021-01237-8. Epub 2021 Feb 6.
Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular diseases. Since the peripheral vestibular system connects with the cerebellum via the brainstem, repeated episodic vertigo may result in progressive structural and functional changes in the cerebellum and brainstem. In the present work, voxel-based morphometry (VBM) of T1-weighted images and resting-state functional magnetic resonance imaging (fMRI) in 32 patients with BPPV and 32 matched healthy controls were used to assess cerebellar and brainstem anatomical and spontaneous resting-state brain activity alterations associated with BPPV. We used a spatially unbiased infratentorial template toolbox in combination with VBM to analyze cerebellar and brainstem gray matter volume (GMV), fractional amplitude of low-frequency fluctuations (fALFF), and regional homogeneity (ReHo). Patients with BPPV showed decreased GMV in the right cerebellum posterior lobe/cerebellar tonsil extending to the cerebellum anterior lobe and pons relative to healthy controls. BPPV patients also exhibited significantly higher fALFF values in the right pons and left pons and higher ReHo values in the left cerebellum posterior lobe/Crus2 than the controls. Furthermore, the fALFF z-scores in the pons were positively correlated with the duration of vertigo at baseline and dizziness visual analog scale scores 1 week after canalith repositioning procedures (CRPs). BPPV patients exhibited structural and functional changes in the cerebellum and pons, which may reflect the adaptation and plasticity of these anatomical structures after repeated attacks of episodic vertigo. These results indicate that the changes in pons function may be closely related to residual dizziness after CRPs.
良性阵发性位置性眩晕（BPPV）是最常见的周围性前庭疾病之一。由于周围前庭系统通过脑干与小脑相连，反复出现阵发性眩晕可能导致小脑和脑干的结构和功能进行性改变。在本研究中，我们使用基于体素的形态学（VBM）和静息态功能磁共振成像（fMRI）对 32 例 BPPV 患者和 32 名匹配的健康对照者进行了研究，以评估与 BPPV 相关的小脑和脑干解剖结构和自发性静息态脑活动改变。我们使用空间无偏下颅模板工具箱结合 VBM 来分析小脑和脑干灰质体积（GMV）、低频振幅（fALFF）和局部一致性（ReHo）。与健康对照组相比，BPPV 患者的右侧小脑后叶/小脑扁桃体延伸至小脑前叶和脑桥的 GMV 减少。BPPV 患者的右侧脑桥和左侧脑桥的 fALFF 值也显著升高，左侧小脑后叶/Crus2 的 ReHo 值也显著升高。此外，脑桥的 fALFF z 分数与基线时眩晕持续时间和耳石复位治疗（CRPs）后 1 周的眩晕视觉模拟评分（VAS）呈正相关。BPPV 患者小脑和脑桥的结构和功能发生了改变，这可能反映了这些解剖结构在反复阵发性眩晕发作后的适应和可塑性。这些结果表明，脑桥功能的改变可能与 CRPs 后残留的头晕密切相关。
