Impaired vestibulo-spinal interaction in cerebellar patients [Elektronische Ressource] / vorgelegt von Stefan Kammermeier

Stefan Kammermeier

Sujets

• Gesundheit

Informations

• Publié par: ludwig-maximilians-universitat_munchen
• Publié le: 01 janvier 2010
• Nombre de lectures: 26
• Langue: Deutsch
• Poids de l'ouvrage: 5 Mo

Extrait

Aus dem Institut für Klinische Neurowissenschaften

Vorstand: Prof. Dr. med. T. Brandt




I m p a i r e d V e s t i b u l o – S p i n a l I n t e r a c t i o n

i n C e r e b e l l a r P a t i e n t s





Dissertation

zum Erwerb des Doktorgrades der Medizin
an der Medizinischen Fakultät der
Ludwig+Maximilians+Universität München



Vorgelegt von
Stefan Kammermeier
aus
Rosenheim
im Jahr
2010







Mit Genehmigung der Medizinischen Fakultät
der Universität München



Berichterstatter: Prof. Dr. med. Ulrich Büttner

Mitberichterstatter: Prof. Dr. med. Jochen Herms
Prof. Dr. med. Winfried Lange


Mitbetreuung durch den
promovierten Mitarbeiter: Dr. med. Justus F. Kleine


Dekan: Prof. Dr. med. Dr. h.c. Maximilian Reiser, FACR, FRCR

Tag der mündlichen Prüfung: 1. Juli 2010





2 Table of Contents
1 Introduction.................................................................................................................................................... 4
2 Background ................................................................................................................................................... 9
2.1 Anatomical and functional review of the underlying circuitry ......................................................... 9
2.1.1 The peripheral vestibular system and its afferents................................................................ 10
2.1.2 The vestibular nuclear complexes ........................................................................................... 18
2.1.3 The cerebellum and the inferior olivary complex ................................................................... 21
2.1.4 Neck and spine ........................................................................................................................... 30
2.1.5 Anatomical summary.................................................................................................................. 33
2.2 Galvanic vestibular stimulation and its postural effects ................................................................ 34
2.2.1 Fundamentals of galvanic vestibular stimulation ................................................................... 34
2.2.2 Perceived movement and postural reactions ......................................................................... 35
2.2.3 Galvanic vestibular stimulation and head position................................................................. 40
3 Materials and Methods .............................................................................................................................. 41
3.1.1 Inclusion and exclusion criteria for control subjects .............................................................. 41
3.1.2 Inclusion and exclusion criteria for patients............................................................................ 42
3.2 Clinical assessment............................................................................................................................ 43
3.3 Experimental setup............................................................................................................................. 45
3.3.1 Force transducer platform ......................................................................................................... 45
3.3.2 Head restraining and posture ................................................................................................... 46
3.3.3 Galvanic stimulation ................................................................................................................... 48
3.4 Data analysis and statistics............................................................................................................... 50
4 Results ......................................................................................................................................................... 54
4.1 Clinical examination ........................................................................................................................... 54
4.2 Body sway without galvanic vestibular stimulation........................................................................ 55
4.3 Body sway under galvanic vestibular stimulation .......................................................................... 56
4.3.1 Individual effects ......................................................................................................................... 56
4.3.2 Group analysis ............................................................................................................................ 60
4.3.3 Clinical head+on+trunk interaction deficits............................................................................... 67
4.4 Summary of Results........................................................................................................................... 73
5 Discussion ................................................................................................................................................... 74
5.1 Experimental groundwork for this study.......................................................................................... 74
5.2 Vestibular+neck interaction in control subjects............................................................................... 75
5.3 Vestibular+neck interaction deficits in cerebellar patients............................................................. 76
5.4 Body sway and compensation for head turns in cerebellar disease........................................... 77
5.5 Vestibular, proprioceptive and visual interaction ........................................................................... 80
5.6 General theories on cerebellar function revisited .......................................................................... 82
5.7 A separate entity of the anterior lobe syndrome?.......................................................................... 83
5.8 Suggested clinical implications......................................................................................................... 86
5.9 Prospectus........................................................................................................................................... 88
6 Summary ..................................................................................................................................................... 89
6.1 Summary in English ........................................................................................................................... 89
6.2 Zusammenfassung auf Deutsch....................................................................................................... 92
7 Index of References ................................................................................................................................... 95
8 Acknowledgements .................................................................................................................................. 105
9 Curriculum Vitae and Declaration of Originality ................................................................................... 106
10 Publications ........................................................................................................................................... 107
10.1 Periodicals ..................................................................................................................................... 107
10.2 Conference Abstracts .................................................................................................................. 107
10.3 Conference Plenary Lectures ..................................................................................................... 107
10.4 Conference Poster Presentations .............................................................................................. 107



3 1 Introduction

Imagine a man walking down a gravelly pavement. He may trip over a stone in his path and tumble. In
such an instance, an intact balance control system allows preventing a fall.
The vestibular organs, deep inside the temporal bones on each side of the skull, are essential for this
ability. They can detect movements of the head in space, like the sudden propulsion when tripping
over a stone. Information from these sensory organs is sent to the brain by the vestibular nerve.
There, a complex program of compensatory muscle activity is calculated in order to counter+act – and
eventually to compensate for – the disturbance: muscle activity in torso and limbs keeps the individual
in balance.

The same mechanism applies for an upright standing man being pushed against the chest (Figure 1a).
With the head pointing straight ahead, the perceived acceleration backwards – relative to head and
trunk – must be counter+acted by postural control, such as by leaning forward or taking a step back.
Here, head and trunk are aligned in a neutral position to each other.

Figure 1
a) b)

Figure 1:

Figure 1a depicts a man receiving a backward push, while his head is pointing straight ahe