Sebastian Wurthmann1, Steffen Naegel2, Benedict Schulte Steinberg3, Nina Theysohn4, Hans-Christoph Diener5, Christoph Kleinschnitz6, Mark Obermann7, Dagny Holle8. 1. Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany. Electronic address: sebastian.wurthmann@uk-essen.de. 2. Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany. Electronic address: steffen.naegel@uk-essen.de. 3. Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany. Electronic address: benedict.schulte-steinberg@uk-essen.de. 4. Institute for Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Germany. Electronic address: nina.theysohn@uk-essen.de. 5. Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany. Electronic address: hans.diener@uk-essen.de. 6. Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany. Electronic address: christoph.kleinschnitz@uk-essen.de. 7. Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany; Center for Neurology, Asklepios Hospitals Schildautal, Karl-Herold-Straße 1, 38723 Seesen, Germany. Electronic address: mark.obermann@uk-essen.de. 8. Department of Neurology and Dizziness, Vertigo Center Essen, University of Duisburg-Essen, Germany. Electronic address: dagny.holle@uk-essen.de.
Abstract
BACKGROUND: Persistent postural perceptual dizziness (PPPD) is the most common vestibular syndrome in middle-aged patients. Multisensory maladjustment involving alterations of sensory response pattern including vestibular, visual and motion stimuli is thought to be a key pathophysiological correlate of this disorder. OBJECTIVE: We aimed to identify regional gray matter changes in PPPD patients that might be involved in the underlying pathophysiology of this disorder. METHODS: 42 PPPD patients and healthy age and gender matched controls were investigated using magnetic resonance imaging-based voxel-based morphometry. All patients fulfilled the current diagnostic criteria for PPPD, established by the Bárány-Society based on previous criteria for chronic subjective dizziness and phobic postural vertigo. RESULTS: PPPD patients showed gray matter volume decrease in the temporal cortex, cingulate cortex, precentral gyrus, hippocampus, dorsolateral prefrontal cortex, caudate nucleus and the cerebellum. A negative correlation of disease duration and gray matter volume was observed in the visual cortex, supplementary motor area and somatosensory processing structures. CONCLUSIONS: In patients with PPPD areas involved in multisensory vestibular processing show gray matter volume decrease. These brain regions resemble those previously described for other vestibular disorders. Longer duration of disease leads to a more pronounced gray matter alteration, which might represent maladaptive mechanisms within the course of disease.
BACKGROUND: Persistent postural perceptual dizziness (PPPD) is the most common vestibular syndrome in middle-aged patients. Multisensory maladjustment involving alterations of sensory response pattern including vestibular, visual and motion stimuli is thought to be a key pathophysiological correlate of this disorder. OBJECTIVE: We aimed to identify regional gray matter changes in PPPD patients that might be involved in the underlying pathophysiology of this disorder. METHODS: 42 PPPD patients and healthy age and gender matched controls were investigated using magnetic resonance imaging-based voxel-based morphometry. All patients fulfilled the current diagnostic criteria for PPPD, established by the Bárány-Society based on previous criteria for chronic subjective dizziness and phobic postural vertigo. RESULTS: PPPD patients showed gray matter volume decrease in the temporal cortex, cingulate cortex, precentral gyrus, hippocampus, dorsolateral prefrontal cortex, caudate nucleus and the cerebellum. A negative correlation of disease duration and gray matter volume was observed in the visual cortex, supplementary motor area and somatosensory processing structures. CONCLUSIONS: In patients with PPPD areas involved in multisensory vestibular processing show gray matter volume decrease. These brain regions resemble those previously described for other vestibular disorders. Longer duration of disease leads to a more pronounced gray matter alteration, which might represent maladaptive mechanisms within the course of disease.