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CC BY-NC-ND 4.0 · Int Arch Otorhinolaryngol 2021; 25(03): e355-e364
DOI: 10.1055/s-0040-1716572
Original Research

Cerebral Responses to Stationary Emotional Stimuli Measured by fMRI in Women with Persistent Postural-Perceptual Dizziness

Eliane Maria Dias von Söhsten Lins 
1   Department of Otorhinolaryngology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
,
Roseli Saraiva Moreira Bittar 
1   Department of Otorhinolaryngology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
,
Paulo Rodrigo Bazán 
2   Department of Radiology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
,
Edson Amaro Júnior 
2   Department of Radiology, Hospital das Clínicas, Universidade de São Paulo, São Paulo, SP, Brazil
,
Jeffrey Paul Staab 
3   Department of Psychiatry, Mayo Clinic, Rochester, USA
› Author Affiliations
Funding Fundação de Amparo à Pesquisa do Estado de São Paulo (Grant/Award Number: '11/51266-5′)
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Abstract

Introduction Persistent postural-perceptual dizziness (PPPD) is a functional vestibular disorder characterized by chronic dizziness, unsteadiness, and hypersensitivity to motion. Preexisting anxiety disorders and neurotic personality traits confer vulnerability to PPPD. High anxiety during acute vertigo or dizziness incites it. A functional magnetic resonance imaging (fMRI) study of chronic subjective dizziness found unexpectedly hypoactive responses to vestibular stimulation in cortical regions that integrate threat assessment and spatial perception.

Objective This fMRI study used non-moving, but emotionally charged visual stimuli to investigate the brain's activity of PPPD patients and control subjects.

Methods The participants included 16 women with PPPD and 16 age-matched women who recovered completely from acute episodes of vertigo or dizziness capable of triggering PPPD. Brain responses to positive, neutral, and negative figures from the International Affective Picture System were measured with fMRI and compared between the groups. Dizziness handicap, anxiety, and depression were assessed with validated questionnaires.

Results Between group analyses: Participants with PPPD showed reduced activity in anterior cingulate cortex and increased activity in left angular gyrus in response to negative versus positive stimuli, which was not observed in recovered individuals. Within group analyses: Participants with PPPD had increased activity in visuospatial areas (parahippocampal gyrus, intraparietal sulcus) in negative versus positive and negative versus neutral contrasts, whereas recovered individuals had increased activity in anxiety regions (amygdala, orbitofrontal cortex).

Conclusion Patients with PPPD may be more attuned to spatial elements than to the content of emotionally charged visual stimuli.

Keywords

anxiety - angular gyrus - anterior cingulate cortex - chronic dizziness - functional magnetic resonance imaging - persistent postural perceptual dizziness


Publication History

Received: 03 April 2020

Accepted: 23 July 2020

Article published online:
24 September 2020

© 2020. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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