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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.01035

Altered resting-state functional connectivity in Wernicke’s encephalopathy with vestibular impairment

  • 1Chonbuk National University Hospital, South Korea
  • 2Medical School, Chonbuk National University, South Korea
  • 3Department of Neurology, Chonbuk National University, South Korea
  • 4Department of Biomedical Engineering, Hanyang University, South Korea
  • 5Department of Neurology, Chonbuk National University Hospital, South Korea
  • 6Department of Neurology, College of Medicine, Seoul National University, South Korea
  • 7Department of Neurology, Hospital of the University of Munich, Germany

Objectives To reveal the neural basis of Wernicke’s encephalopathy (WE) with impaired vestibulo-ocular reflex (VOR), we evaluated resting-state functional connectivity (rs-fc) in the vestibular processing brain regions.
Methods: Rs-fc between the vestibular regions and the rest of the brain were compared with neurotological features including the head-impulse tests (vHIT) and caloric responses in patients with WE (n=5, mean age 53.4 ± 10 years) and healthy controls (n=20, mean age 55.0 ± 9.2 years). Rs-fc analyses employed a region of interest (ROI)-based approach using regions selected a priori that participate in vestibular processing including the cerebellar vermis, insula, parietal operculum, and calcarine cortex.
Results: The main neurologic findings for patients with WE were mental changes; gait ataxia; spontaneous and gaze-evoked nystagmus (GEN); and bilaterally positive HIT for the horizontal canals. Video HIT documented bilateral horizontal canal dysfunction with decreased gain and corrective saccades. Caloric irrigation and rotation chair testing revealed prominent bilateral horizontal canal paresis. Patients with WE also had decreased spatial memory, which substantially recovered after treatments. Functional connections at the predefined seed regions, including the insular cortex and parietal operculum, were attenuated in the WE group compared to healthy controls.
Conclusions WE is related to impaired VOR and visuospatial dysfunction, and fMRI documented changes in the rs-fc of multisensory vestibular processing regions including the insula, parietal operculum, and superior temporal gyrus, which participate in integration of vestibular perception.

Keywords: Wernicke’s encephalopathy, Vestibule-ocular reflex (VOR), Head-impulse test, functional connectivity, fMRI, vestibular cortex, Insula cortex

Received: 14 Jul 2019; Accepted: 12 Sep 2019.

Copyright: © 2019 Kang, Lee, Oh, Park, Kim, Lee, Kim and Dieterich. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Sun-Young Oh, Chonbuk National University, Department of Neurology, Jeonju, 561-712, South Korea, ohsun@chonbuk.ac.kr