Vestibular neuritis: Vertigo and the high-acceleration vestibulo-ocular reflex

Abstract : Patients after vestibular neuritis (VN) often report persistent dizziness and disequilibrium. We correlated persistent symptoms with sustained impairment of the high-acceleration horizontal vestibulo-ocular reflex as determined by quantitative searchcoil head-impulse testing (qHIT). In 47 patients, qHIT was recorded 0-60 months and symptoms assessed with the Yardley Vertigo Symptom Scale short form ≥ 18 months after VN onset. No correlation between the magnitude of high-acceleration vestibular impairment and the severity of vertigo symptoms was observed. The lack of a symptom-qHIT correlation suggests that defective compensation at a more rostral level in the central nervous system may be responsible for protracted symptoms in VN patient

Visually guided adjustments of body posture in the roll plane

Body position relative to gravity is continuously updated to prevent falls. Therefore, the brain integrates input from the otoliths, truncal graviceptors, proprioception and vision. Without visual cues estimated direction of gravity mainly depends on otolith input and becomes more variable with increasing roll-tilt. Contrary, the discrimination threshold for object orientation shows little modulation with varying roll orientation of the visual stimulus. Providing earth-stationary visual cues, this retinal input may be sufficient to perform self-adjustment tasks successfully, with resulting variability being independent of whole-body roll orientation. We compared conditions with informative (earth-fixed) and non-informative (body-fixed) visual cues. If the brain uses exclusively retinal input (if earth-stationary) to solve the task, trial-to-trial variability will be independent from the subject's roll orientation. Alternatively, central integration of both retinal (earth-fixed) and extra-retinal inputs will lead to increasing variability when roll-tilted. Subjects, seated on a motorized chair, were instructed to (1) align themselves parallel to an earth-fixed line oriented earth-vertical or roll-tilted 75° clockwise; (2) move a body-fixed line (aligned with the body-longitudinal axis or roll-tilted 75° counter-clockwise to it) by adjusting their body position until the line was perceived earth-vertical. At 75° right-ear-down position, variability increased significantly (p<0.05) compared to upright in both paradigms, suggesting that, despite the earth-stationary retinal cues, extra-retinal input is integrated. Self-adjustments in the roll-tilted position were significantly (p<0.01) more precise for earth-fixed cues than for body-fixed cues, underlining the importance of earth-stable visual cues when estimates of gravity become more variable with increasing whole-body rol

Alexander's Law in Patients with Acute Vestibular Tone Asymmetry—Evidence for Multiple Horizontal Neural Integrators

Alexander's law (AL) states that the slow-phase velocity of spontaneous nystagmus of peripheral vestibular origin is dependent on horizontal gaze position, with greater velocity when gaze is directed in the fast-phase direction. AL is thought to be a compensatory reaction resulting from adaptive changes in the horizontal ocular motor neural integrator. Until now, only horizontal eye movements have been investigated with respect to AL. Because spontaneous nystagmus usually includes vertical and torsional components, we asked whether horizontal gaze changes would have an effect on the 3D drift of spontaneous nystagmus and, thus, on the vertical/torsional neural integrator. We hypothesized that AL reduces all nystagmus components proportionally. Moreover, we questioned the classical theory of a single bilaterally organized horizontal integrator and searched for nonlinearities of AL implying a network of multiple integrators. Using dual scleral search coils, we measured AL in 17 patients with spontaneous nystagmus. Patients followed a pulsed laser dot at eye level jumping in 5° steps along the horizontal meridian between 25° right and left in otherwise complete darkness. AL was observed in 15 of 17 patients. Whereas individual patients typically showed a change of 3D-drift direction at different horizontal eye positions, the average change in direction was not different from zero. The strength of AL (= rate of change of total velocity with gaze position) correlated with nystagmus slow-phase velocity (Spearman's rho = 0.5; p < 0.05) and, on average, did not change the 3D nystagmus drift direction. In general, eye velocity did not vary linearly with eye position. Rather, there was a stronger dependence of velocity on horizontal position when subjects looked in the slow-phase direction compared to the fast-phase direction. We conclude that the theory of a simple leak of a single horizontal neural integrator is not sufficient to explain all aspects of A

The linear growth rate of structure in Parametrized Post Friedmannian Universes

A possible solution to the dark energy problem is that Einstein's theory of general relativity is modified. A suite of models have been proposed that, in general, are unable to predict the correct amount of large scale structure in the distribution of galaxies or anisotropies in the Cosmic Microwave Background. It has been argued, however, that it should be possible to constrain a general class of theories of modified gravity by focusing on properties such as the growing mode, gravitational slip and the effective, time varying Newton's constant. We show that assuming certain physical requirements such as stability, metricity and gauge invariance, it is possible to come up with consistency conditions between these various parameters. In this paper we focus on theories which have, at most, 2nd derivatives in the metric variables and find restrictions that shed light on current and future experimental constraints without having to resort to a (as yet unknown) complete theory of modified gravity. We claim that future measurements of the growth of structure on small scales (i.e. from 1-200 h^{-1} Mpc) may lead to tight constraints on both dark energy and modified theories of gravity.Comment: 15 Pages, 11 Figure

Vestibular and auditory deficits in Fabry disease and their response to enzyme replacement therapy

Progressive hearing (pHL) and vestibular (pVL) loss are frequent deficits in Fabry disease (FD). Recently, enzyme replacement therapy (ERT) with human α-galactosidase A has become available. Here, we investigate the association between pHL and pVL in FD and their ERT responses. Pure tone audiometry (PTA) and head impulse testing (HIT) were administered at baseline in 47 patients (25 male, 18-0 y; 22 female, 17-4 y), of whom 24 also received caloric irrigation (CI). Of the 47 patients, 38 (24 male) were tested both before and during ERT (follow- up ≤60 months). ERT consisted of agalsidase alfa infusions. At baseline, pHL was present in 88% of males and 86% of females. Over all tested frequencies (range: 0.5- kHz), pHL was significantly (two-way ANOVA: p 0.05). We conclude that pHL and pVL prevalences are similar in FD. To detect pVL, HIT is more sensitive than CI. We speculate that pHL and pVL emerge from lesions within the vestibulocochlear labyrinth, because no specific patterns of vestibulo-cochlear deficits were observed, as expected if lesions were more proximal along the inferior or superior branch of the vestibulo-cochlear nerve or labyrinthine artery. Finally, ERT stabilizes auditory and even improves vestibular functio

O(4) texture with a cosmological constant

We investigate O(4) textures in a background with a positive cosmological constant. We find static solutions which co-move with the expanding background. There exists a solution in which the scalar field is regular at the horizon. This solution has a noninteger winding number smaller than one. There also exist solutions in which scalar-field derivatives are singular at the horizon. Such solutions can complete one winding within the horizon. If the winding number is larger than some critical value, static solutions including the regular one are unstable under perturbations.Comment: 25 pages, revtex, 6 eps figure

Gravitomagnetism, clocks and geometry

New techniques to evaluate the clock effect using light are described. These are based on the flatness of the cylindrical surface containing the world lines of the rays constrained to move on circular trajectories about a spinning mass. The effect of the angular momentum of the source is manifested in the fact that inertial observers must be replaced by local non rotating observers. Starting from this an exact formula for circular trajectories is found. Numerical estimates for the Earth environment show that light would be a better probe than actual clocks to evidence the angular momentum influence. The advantages of light in connection with some principle experiments are shortly reviewed.Comment: TCI Latex, 12 pages, 2 figures. To appear in European Journal of Physic

On Gravitational Waves in Spacetimes with a Nonvanishing Cosmological Constant

We study the effect of a cosmological constant $\Lambda$ on the propagation and detection of gravitational waves. To this purpose we investigate the linearised Einstein's equations with terms up to linear order in $\Lambda$ in a de Sitter and an anti-de Sitter background spacetime. In this framework the cosmological term does not induce changes in the polarization states of the waves, whereas the amplitude gets modified with terms depending on $\Lambda$. Moreover, if a source emits a periodic waveform, its periodicity as measured by a distant observer gets modified. These effects are, however, extremely tiny and thus well below the detectability by some twenty orders of magnitude within present gravitational wave detectors such as LIGO or future planned ones such as LISA.Comment: 8 pages, 4 figures, accepted for publication in Physical Review

On Doppler tracking in cosmological spacetimes

We give a rigorous derivation of the general-relativistic formula for the two-way Doppler tracking of a spacecraft in Friedmann-Lemaitre-Robertson-Walker and in McVittie spacetimes. The leading order corrections of the so-determined acceleration to the Newtonian acceleration are due to special-relativistic effects and cosmological expansion. The latter, although linear in the Hubble constant, is negligible in typical applications within the Solar System.Comment: 10 pages, 1 figure. Journal versio