Journal of the neurological sciences · 2025
Early improvement in vertigo intensity after subacute infratentorial infarction relates to vestibulocerebellar network damage and balance recovery: A retrospective disconnectome study.
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Hirano Shingo, Igarashi Tatsuya, Kawaguchi Atsushi, Sakamoto Maiko, Nakazono Hisato, Taniguchi Takanori, Inooka Hiroyuki, Mitsutake Tsubasa
Аннотация
BACKGROUND: Central vertigo frequently occurs in patients with stroke and is associated with impaired activities of daily living and fall risk. However, the neural substrates underlying recovery, their relationship with balance, and longitudinal changes remain unclear. We applied structural disconnectome analysis to clarify whether improvement in vertigo relates to infratentorial white-matter tract damage and balance gains.
METHODS: We retrospectively studied 30 inpatients with subacute infratentorial ischemic stroke who reported vertigo (Numeric Rating Scale [NRS] ≥1) at admission (12 men, mean age 68.5 ± 14.2 years). Diffusion-weighted imaging at admission quantified percent damage across 17 infratentorial white-matter tracts using the Lesion Quantification Toolkit. Vertigo severity (NRS) and balance (Berg Balance Scale [BBS]) were measured at admission and at 1 month; NRS improvement and BBS change (ΔBBS) were calculated. Patients were classified as improved-vertigo (NRS = 0 at 1 month; n = 15) or residual-vertigo (NRS ≥1; n = 15).
RESULTS: Relative to the improved-vertigo group, the residual-vertigo group showed higher percent damage in the cerebellar vermis, cerebellar hemispheres, and inferior cerebellar peduncle. Damage in the vermis and hemispheres correlated positively with NRS at admission and follow-up and negatively with NRS improvement. Inferior cerebellar peduncle damage correlated positively with admission NRS and negatively with NRS improvement. Within the residual-vertigo group, NRS improvement correlated positively with ΔBBS.
CONCLUSIONS: Greater damage within the vestibulocerebellar network and cerebellar hemispheres may be correlated with recovery of vertigo. In patients with residual vertigo, the degree of vertigo is related to balance gains. These findings may inform rehabilitation planning and prognosis after infratentorial stroke.
METHODS: We retrospectively studied 30 inpatients with subacute infratentorial ischemic stroke who reported vertigo (Numeric Rating Scale [NRS] ≥1) at admission (12 men, mean age 68.5 ± 14.2 years). Diffusion-weighted imaging at admission quantified percent damage across 17 infratentorial white-matter tracts using the Lesion Quantification Toolkit. Vertigo severity (NRS) and balance (Berg Balance Scale [BBS]) were measured at admission and at 1 month; NRS improvement and BBS change (ΔBBS) were calculated. Patients were classified as improved-vertigo (NRS = 0 at 1 month; n = 15) or residual-vertigo (NRS ≥1; n = 15).
RESULTS: Relative to the improved-vertigo group, the residual-vertigo group showed higher percent damage in the cerebellar vermis, cerebellar hemispheres, and inferior cerebellar peduncle. Damage in the vermis and hemispheres correlated positively with NRS at admission and follow-up and negatively with NRS improvement. Inferior cerebellar peduncle damage correlated positively with admission NRS and negatively with NRS improvement. Within the residual-vertigo group, NRS improvement correlated positively with ΔBBS.
CONCLUSIONS: Greater damage within the vestibulocerebellar network and cerebellar hemispheres may be correlated with recovery of vertigo. In patients with residual vertigo, the degree of vertigo is related to balance gains. These findings may inform rehabilitation planning and prognosis after infratentorial stroke.