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Brain Advance Access originally published online on September 4, 2008
Brain 2008 131(11):2928-2935; doi:10.1093/brain/awn201
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© The Author (2008). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

An ipsilateral vestibulothalamic tract adjacent to the medial lemniscus in humans

Andreas Zwergal1, Jean Büttner-Ennever2, Thomas Brandt1 and Michael Strupp1

1Department of Neurology and 2Department of Anatomy Ludwig-Maximilians-University, Klinikum Grosshadern, Munich, Germany

Correspondence to: Andreas Zwergal, MD, Department of Neurology, University of Munich, Klinikum Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany E-mail: andreas.zwergal{at}med.uni-muenchen.de

We examined 14 patients with acute anteromedial pontomesencephalic infarctions for signs of vestibular and ocular motor dysfunction. In all cases, an isolated ipsilateral deviation of the subjective visual vertical (mean: 4.1, range: 2.7– 6.6) was found without any further signs of vestibular or eye movement disorders like ocular torsion or skew deviation. Distinct lesions in thin-slice brainstem MRI showed an overlap zone in the medial portion of the medial lemniscus. The finding of putative ipsilateral vestibular projections running adjacent to or within the medial lemniscus was subsequently confirmed by a reanalysis of an anterograde tracer labelling study in the primate after tracer injection in the vestibular nucleus complex. The major conclusions of this study are as follows: (i) there is evidence for an ipsilateral graviceptive pathway running from the vestibular nuclei close to and within the medial lemniscus to the posterolateral thalamus [ipsilateral vestibulothalamic tract (IVTT)], (ii) this pathway might be the human homologue of the three-neuron sensory vestibulocortical tract described in primates and (iii) unilateral lesions of this pathway cause only vestibulo-perceptive dysfunction in the roll plane in contrast to lesions of the crossed graviceptive pathways (in the medial longitudinal fascicle), which were described earlier and which manifest as a combination of tilt of the subjective visual vertical, ocular torsion and skew deviation.

Key Words: vestibular system; imaging; information processing

Abbreviations: IVTT, ipsilateral vestibulo-thalamic tract; INC, interstitial nucleus of Cajal; MLF, medial longitudinal fascicle; SVV, subjective visual vertical

Received May 6, 2008. Revised July 24, 2008. Accepted July 31, 2008.


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