Evidence for interacting cortical control of vestibular function and spatial representation in man.

The objective of this research was to determine the possible relation between deficits in spatial representation capability and vestibular function following cortical lesions. We thus investigated vestibulo-ocular behaviour in a group of 14 patients with unilateral cortical damage involving the occipito-temporo-parietal junction. Patients were divided in three sub-groups: (1) Group R+: five patients with right sided cortical lesions associated with a left hemi-neglect, (2) Group R-: four patients with right sided cortical lesions with no hemi-neglect and (3) Group L: five patients with left-sided cortical lesions. The patient groups were compared to a group of eight healthy age-matched subjects. The vestibulo-ocular reflex (VOR) was tested in complete darkness by rotating the subject around the vertical axis by sinusoidal rotation at different frequencies, and by steps of acceleration or deceleration. The nystagmus slow phase velocity was measured and plotted as a function of the head velocity and the VOR parameters including gain, bias, time constant and phase were calculated. The cortical lesions induced a significant VOR asymmetry in terms of: a directional preponderance of the VOR gain to the contralesion side, only during sinusoidal rotation, and, in contrast, a VOR bias and a directional preponderance of the VOR time constant and of the nystagmus frequency to the side of the cortical lesion. These latter VOR deficits were the most significant in the R+ group, i.e. in right cortical lesions with hemi-neglect syndrome. These results demonstrate in man, the existence of a cortical influence on vestibular function related to the mechanisms of spatial representation.