Funktionelle Bildgebung des vestibulären Systems

Zusammenfassung

In den letzten Jahren konnte mithilfe der funktionellen Bildgebung des menschlichen Gehirns neue Erkenntnisse zum Gleichgewichtssystem gewonnen werden. Basis für die Auswertung dieser Untersuchungen waren die Kenntnisse aus älteren neurophysiologischen und Tracer-Studien an Tieren zum vestibulären System im Kortex. Aus diesen Studien sind mehrere Areale im Großhirn, vor allem im temporo-parietalen Kortex, bekannt, die ein Netzwerk bilden mit dem Zentrum im parietoinsulären vestibulären Kortex (PIVC). Heute weiß man aus funktionellen Bildgebungsstudien, dass ein solches Netzwerk auch beim Menschen existiert und die Aktivierungen des Netzwerkes während vestibulärer Stimulation nicht gleichmäßig in beiden Hemisphären verteilt sind, sondern mit einer Betonung in der rechten Hemisphäre bei Rechtshändern und in der linken Hemisphäre bei Linkshändern sowie ipsilateral zum stimulierten Ohr. Diese Aktivierungs-Deaktivierungsmuster Gesunder sind spezifisch verändert bei Patienten mit vestibulären Erkrankungen, je nachdem welche Schaltstelle im vestibulären System geschädigt wurde.

Summary

In this article we will discuss our current knowledge of multisensory vestibular structures and their functions in the human cortex. Most of it derives from brain activation studies with PET and fMRI in humans conducted over the last decade. They have confirmed the existence of several separate and distinct cortical areas that were identified earlier by tracer and electrophysiological studies in animals. The patterns of activations and deactivations during vestibular stimulations in healthy subjects have been compared with those in patients with acute and chronic peripheral and central vestibular disorders. The following reviews what is presently known about the interconnections of vestibular structures, their activations and interactions with other sensory modalities, and the changes that result from strategic unilateral peripheral and central vestibular lesions such as vestibular neuritis and bilateral vestibular failure, on the one hand, and central vestibular lesions due to e.g. unilateral ischemic infarctions of the posterolateral thalamus, on the other.

Schlüsselwörter

Vestibuläre Erkrankungen - Schwindel - funktionelle Bildgebung - fMRT - PET

Keywords

Vestibular disorders - vertigo - functional imaging - fMRI - PET

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