Li Yanran, Qi Lei, Schaper Frédéric L W V J, Wu Di, Friedrich Maximilian, Du Jialin, Yu Tao, Wang Qiao, Wang Xiaopeng, Wang Di, Jin Guangyuan, Liu Aihua, Fan Chunqiu, Wang Yuping, Fox Michael D, Ren Liankun
Department of Neurology, Clinical Center for Epilepsy, Xuanwu Hospital, Capital Medical University, National Center for Neurological Disorders, Beijing 100053, China.
Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Brain Commun. 2023 Mar 17;5(2):fcad071. doi: 10.1093/braincomms/fcad071. eCollection 2023.
Vertigo is a common neurological complaint, which can result in significant morbidity and decreased quality of life. While pathology to peripheral and subtentorial brain structures is a well-established cause of vertigo, cortical lesions have also been linked to vertigo and may lend insight into relevant neuroanatomy. Here, we investigate the supratentorial lesion locations associated with vertigo and test whether they map to a common brain network. We performed a systematic literature search and identified 23 cases of supratentorial brain lesions associated with vertigo. We mapped the lesion locations to a standard brain template and computed the network of brain regions functionally connected to each lesion location, using a 'wiring diagram' of the human brain termed the human connectome ( = 1000). Sensitivity was assessed by identifying the most common connection to lesion locations associated with vertigo, and specificity was assessed through comparison with control lesions associated with symptoms other than vertigo ( = 68). We found that functional connectivity between lesion locations and the bilateral ventral posterior insula was both sensitive (22/23 lesions) and specific (voxel-wise family-wise error-corrected < 0.05) for lesion-induced vertigo. We computed connectivity with this hub region to define a lesion-based vertigo network, which included regions in the bilateral insula, somatosensory cortex, higher-level visual areas, cingulate sulcus, thalamus and multiple cerebellar regions in the territory of the posterior inferior cerebellar artery. Next, we used stereo-electroencephalography (80 stimulation sites across 17 patients) to test whether stimulation sites associated with vertigo mapped to this same network. We found that 36/42 (86%) of stimulation sites eliciting vertigo fell within the lesion-based vertigo network in contrast to 16/39 (41%) of stimulation sites that did not elicit vertigo. Connectivity between stimulation sites and our lesion-based hub in the ventral posterior insula was also significantly associated with vertigo ( < 0.0001). We conclude that cortical lesions and direct electrical stimulation sites associated with vertigo map to a common brain network, offering insights into the causal neuroanatomical substrate of vertigo.
眩晕是一种常见的神经科病症，可导致严重发病并降低生活质量。虽然外周和幕下脑结构的病变是眩晕的一个公认病因，但皮质病变也与眩晕有关，且可能有助于深入了解相关神经解剖学。在此，我们研究与眩晕相关的幕上病变位置，并测试它们是否映射到一个共同的脑网络。我们进行了系统的文献检索，确定了23例与眩晕相关的幕上脑病变病例。我们将病变位置映射到一个标准脑模板，并使用称为人类连接组（n = 1000）的人类脑“接线图”计算与每个病变位置功能连接的脑区网络。通过确定与眩晕相关病变位置最常见的连接来评估敏感性，并通过与与眩晕以外症状相关的对照病变进行比较来评估特异性（n = 68）。我们发现病变位置与双侧腹侧后岛叶之间的功能连接对病变引起的眩晕既敏感（22/23个病变）又具特异性（体素水平家族性错误校正P < 0.05）。我们计算了与该枢纽区域的连接性，以定义一个基于病变的眩晕网络，该网络包括双侧岛叶、体感皮层、高级视觉区域、扣带沟、丘脑以及小脑后下动脉区域内的多个小脑区域。接下来，我们使用立体脑电图（17例患者共80个刺激位点）来测试与眩晕相关的刺激位点是否映射到同一个网络。我们发现，引发眩晕的刺激位点中有36/42（86%）位于基于病变的眩晕网络内，相比之下，未引发眩晕的刺激位点中有16/39（41%）位于该网络内。刺激位点与我们位于腹侧后岛叶的基于病变的枢纽之间的连接性也与眩晕显著相关（P < 0.0001）。我们得出结论，与眩晕相关的皮质病变和直接电刺激位点映射到一个共同的脑网络，这为眩晕的因果神经解剖学基础提供了见解。
