Update on Clinical Physiology and Pathomechanisms for Vestibulo-Autonomic Interplay.

The vestibulo-autonomic interaction refers to the neural interplay between the vestibular and autonomic systems. In particular, the vestibular system plays an active role in adjusting blood distribution during movement and changes in posture, thereby complementing the baroreflex. This review summarizes recent clinical evidence highlighting the interaction between the vestibular and autonomic systems, including altered vestibular-evoked myogenic potentials in patients with postural orthostatic tachycardia syndrome, orthostatic hypotension, and neurodegenerative disorders. Additionally, the review introduces a model-based explanation of vestibular modulation of the autonomic system via the velocity storage mechanism. Specifically, the model demonstrates how vertigo attacks influence cardiovascular autonomic outflow by altering the estimation of gravity and inertia under pathological conditions.