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Denis Pelisson - One of the best experts on this subject based on the ideXlab platform.
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Effects of structural and functional cerebellar lesions on sensorimotor adaptation of saccades
Experimental Brain Research, 2013Co-Authors: Muriel Panouilleres, Nadia Alahyane, Romeo Salemme, Christian Urquizar, Caroline Tilikete, Bertrand Gaymard, Norbert Nighoghossian, Denis PelissonAbstract:The cerebellum is critically involved in the adaptation mechanisms that maintain the accuracy of goal-directed acts such as saccadic eye movements. Two categories of saccades, each relying on different adaptation mechanisms, are defined: reactive (externally triggered) saccades and voluntary (internally triggered) saccades. The contribution of the medio-posterior part of the cerebellum to reactive saccades adaptation has been clearly demonstrated, but the evidence that other parts of the cerebellum are also involved is limited. Moreover, the cerebellar substrates of voluntary saccades adaptation have only been marginally investigated. Here, we addressed these two questions by investigating the adaptive capabilities of patients with cerebellar or pre-cerebellar stroke. We recruited three groups of patients presenting focal lesions located, respectively, in the supero-anterior cerebellum, the infero-posterior cerebellum and the lateral medulla (leading to a Wallenberg Syndrome including motor dysfunctions similar to those resulting from lesion of the medio-posterior cerebellum). Adaptations of reactive saccades and of voluntary saccades were tested during separate sessions in all patients and in a group of healthy participants. The functional lesion of the medio-posterior cerebellum in Wallenberg Syndrome strongly impaired the adaptation of both reactive and voluntary saccades. In contrast, patients with lesion in the supero-anterior part of the cerebellum presented a specific adaptation deficit of voluntary saccades. Finally, patients with an infero-posterior cerebellar lesion showed mild adaptation deficits. We conclude that the medio-posterior cerebellum is critical for the adaptation of both saccade categories, whereas the supero-anterior cerebellum is specifically involved in the adaptation of voluntary saccades.
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Saccadic lateropulsion in Wallenberg Syndrome: a window to access cerebellar control of saccades?
Experimental Brain Research, 2006Co-Authors: Caroline Tilikete, Norbert Nighoghossian, Ansgar Koene, Alain Vighetto, Denis PelissonAbstract:Saccadic lateropulsion is characterized by an undershoot of contralaterally directed saccades, an overshoot of ipsilaterally directed saccades and an ipsilateral deviation of vertical saccades. In Wallenberg Syndrome, it is thought to result from altered signals in the olivo-cerebellar pathway to the oculomotor cerebellar network. In the current study we aimed to determine whether saccadic lateropulsion results from a cerebellar impairment of motor related signals or visuo-spatial related signals. We studied the trajectory, the accuracy, the direction and the amplitude of a variety of vertical and oblique saccades produced by Wve patients and nine control subjects. Some results are consistent with previous data suggesting altered motor related signals. Indeed, the horizontal error of contralesional saccades in patients increased with the desired horizontal saccade size. Furthermore, the initial directional error measured during the saccadic acceleration phase was smaller than the global directional error, suggesting that the eye tra-jectory curved progressively. However, some other results suggest that the processes that specify the horizontal spatial goal of the saccades might be impaired in the patients. Indeed, the horizontal error of ipsilesional saccades in patients did not change signiWcantly with the desired horizontal saccade size. In addition, when comparing saccades with similar intended direction, it was found that the directional error was inversely related to the vertical saccade amplitude. Thus we conclude that the cerebellum might be involved both in controlling the motor execution of saccades and in determining the visuo-spatial information about their goal.
Soo Jeong Han - One of the best experts on this subject based on the ideXlab platform.
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Improvement of Quiet Standing Balance in Patients with Wallenberg Syndrome after Rehabilitation
Annals of rehabilitation medicine, 2011Co-Authors: Tae Sik Yoon, Soo Jeong HanAbstract:Objective To evaluate quiet standing balance of patients with Wallenberg Syndrome before and after rehabilitation. Method Six patients with Wallenberg Syndrome were enrolled within one month after being aff ected by an infarct of the lateral medulla. Quiet standing balance was assessed using posturography with eyes open and closed. Th e assessment was repeated after the patients had undergone rehabilitation treatment for three to nine months, and the results of the two assessments were compared. Results The quiet standing balance evaluation was performed by measurement of center of pressure (CoP) movement. In the initial test, the mean scores of mediolateral and anteroposterior speed, velocity movement, mediolateral and anteroposterior extent of CoP were all high, indicating impairments of quiet standing balance in the patients. After rehabilitation treatment, the anteroposterior speed and extent, the mediolateral speed and extent, and velocity moment of CoP showed statistically signifi cant reductions in the eyes open condition (p
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improvement of quiet standing balance in patients with Wallenberg Syndrome after rehabilitation
Annals of Rehabilitation Medicine, 2011Co-Authors: Tae Sik Yoon, Soo Jeong HanAbstract:Objective To evaluate quiet standing balance of patients with Wallenberg Syndrome before and after rehabilitation. Method Six patients with Wallenberg Syndrome were enrolled within one month after being aff ected by an infarct of the lateral medulla. Quiet standing balance was assessed using posturography with eyes open and closed. Th e assessment was repeated after the patients had undergone rehabilitation treatment for three to nine months, and the results of the two assessments were compared. Results The quiet standing balance evaluation was performed by measurement of center of pressure (CoP) movement. In the initial test, the mean scores of mediolateral and anteroposterior speed, velocity movement, mediolateral and anteroposterior extent of CoP were all high, indicating impairments of quiet standing balance in the patients. After rehabilitation treatment, the anteroposterior speed and extent, the mediolateral speed and extent, and velocity moment of CoP showed statistically signifi cant reductions in the eyes open condition (p<0.05), and the anteroposterior speed and extent and velocity moment of CoP had decreased in the eyes closed condition (p<0.05). Mediolateral speed and extent of CoP in the eyes closed condition had also decreased, but the reduction was not statistically signifi cant. Conclusion Th is study demonstrated improvements of quiet standing balance, especially anteroposterior balance, in patients with Wallenberg Syndrome following rehabilitation. We suggest that balance training is important in the rehabilitation of Wallenberg Syndrome and that, as an objective measure of balance status, posturography is useful in the assessment of quiet standing balance.
The Johns Hopkins School Of Medicine - One of the best experts on this subject based on the ideXlab platform.
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Saccadic hypermetria and ipsipulsion (behind closed eyelids and with vertical saccades)
Spencer S. Eccles Health Sciences Library University of Utah, 2018Co-Authors: Daniel R. Gold, Departments Of Neurology, Otolaryngology Head Neck - & Surgery, Emergency Medicine, And Medicine, The Johns Hopkins School Of MedicineAbstract:This is a 40-year-old woman who experienced oscillopsia and vertical diplopia, due to spontaneous torsional nystagmus and a skew deviation (right hypotropia), respectively. The symptom onset was 7 months prior to these videos. MRI demonstrated ill-defined T2 and FLAIR hyperintensity signal changes involving subcortical white matter and throughout the midbrain and ventral medulla suggestive of a demyelinating, vasculitic or inflammatory condition. Although there was no discrete right sided lateral medullary lesion, she had 1) hypermetric saccades to the right, 2) a rightward trajectory with vertical saccades, and 3) rightward ocular lateropulsion (i.e., eyes drift to the right with eyelid closure, also apparent on her MRI), as well as the torsional nystagmus. These are features that are commonly seen with a (right) lateral medullary Syndrome (in addition to her right hypotropia), as the climbing fibers connecting (left) inferior olive to (right) dorsal vermis are injured. See diagram of the normal pathways (https://collections.lib.utah.edu/ark:/87278/s6c8649n), and what happens with a lateral medullary lesion (https://collections.lib.utah.edu/ark:/87278/s67h5cjg). Further work-up (including cerebrospinal fluid analysis) is ongoing, although HIV, SS-A/B, ACE, ANCA, GAD-65, SPEP, NMO, ANA, RPR, and Lyme were negative or normal. For an example of characteristic neurologic and ocular motor findings in a lateral medullary (Wallenberg) Syndrome, see https://collections.lib.utah.edu/ark:/87278/s6963fhm
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The acute vestibular Syndrome with dysarthria, dysphagia, dysphonia, hemi-ataxia, and saccadic dysmetria due to the lateral medullary (Wallenberg) Syndrome
Spencer S. Eccles Health Sciences Library University of Utah, 2017Co-Authors: Daniel R. Gold, Departments Of Neurology, Otolaryngology Head Neck - & Surgery, Emergency Medicine, And Medicine, The Johns Hopkins School Of MedicineAbstract:This is a 50-year-old woman with the acute onset of vertigo, dysarthria, dysphagia and dysphonia/hoarseness (nucleus ambiguus), ptosis and imbalance. Her examination localized to a left lateral medullary (Wallenberg) Syndrome - there was decreased sensation on the left side of the face (spinal trigeminal nucleus and tract) and the right arm and leg (spinothalamic tract), a left Horner's Syndrome (oculosympathetic tract), left hemi-ataxia (inferior cerebellar peduncle), leftward ocular lateropulsion (apparent throughout the video during blinks - during eyelid closure, there is conjugate deviation to the left, and when the eyelids open, the eyes move to the right into primary gaze) which is usually seen with hypermetric saccades to the left (ipsilateral) and hypometric saccades to the right (contralateral), relating to injury of the climbing fibers traveling through the inferior cerebellar peduncle on the left side. Other ocular motor features commonly seen in a lateral medullary Syndrome (not demonstrated in the video) include an ipsiversive ocular tilt reaction (1. skew deviation with a (left) hypotropia ipsilateral to the stroke, 2. ipsilesional (towards the left ear) ocular counterroll, 3. leftward head tilt) due to utricle-ocular motor pathway dysfunction; spontaneous nystagmus which is usually horizontal-torsional or pure torsional due to central semicircular canal pathway dysfunction; gaze-evoked nystagmus due to medial vestibular nucleus dysfunction. [[Number of Videos and legend for each: 1, patient with the acute vestibular Syndrome due to left lateral medullary stroke.]
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+ HIT, + Skew, Unidirectional Nystagmus: Central acute vestibular Syndrome due to Wallenberg Syndrome
Spencer S. Eccles Health Sciences Library University of Utah, 2017Co-Authors: Daniel R. Gold, Departments Of Neurology, Otolaryngology Head Neck - & Surgery, Emergency Medicine, And Medicine, The Johns Hopkins School Of MedicineAbstract:This is a 45-year-old woman who presented to the ED with acute prolonged vertigo and vertical diplopia. She was seen as an outpatient 1 month after her ED visit, and double vision and balance were improving by that time. Her HINTS testing showed the following (seen in the video):; 1); Head Impulse - Abnormal to the right; seen with peripheral>>central conditions; 2); Nystagmus - Unidirectional horizontal-torsional nystagmus, least in right gaze, most in left gaze (Alexander's law); usually seen with peripheral but can be seen with small unilateral central vestibular lesions; 3); Test of Skew - A 3 prism diopter left hypertropia was seen with cover-uncover testing, in addition to a slight head tilt to the right, and ocular counterroll (excyclodeviation OD and incyclodeviation OS) seen with ophthalmoscopy (skew + ocular counterroll + head tilt = ocular tilt reaction); seen with central>>peripheral conditions. Her 3 PD LH decreased to 1 PD LH when measurements were repeated with Maddox rod testing, which again is suggestive of a skew deviation - i.e., when supine, there is less utricle-ocular motor pathway asymmetry as the gravitational forces that act upon the utricles are lessened. ; Regardless of the "peripheral" appearance of the head impulse and nystagmus, the presence of a skew deviation makes this central until proven otherwise. That being said, a small, transient skew deviation can rarely be seen acutely with otherwise typical vestibular neuritis. MR angiogram of the head and neck and MR with diffusion weighted imaging done acutely in the ED (within hours of onset) was negative, although it is thought that up to 20% of small brainstem strokes can be missed by MR-DWI in the first 24 hours. ; In summary, this was either 1) a small brainstem lesion and imaging was done too soon for the lesion to be seen or 2) a rare instance of vestibular neuritis with a small skew deviation (i.e., the utricle fibers are affected within the peripheral vestibular nerve). However, her skew deviation persisted for much longer than what would be expected with a "peripheral" skew deviation (4 weeks in her case, whereas "peripheral" skews should resolve within days unless a severe, destructive utricle injury - as in bacterial labyrinthitis or vestibular nerve section - has occurred), and additionally, there was mild (ipsilesional) ocular lateropulsion to the right and hypometric (contralesional) saccades to the left, both of which are commonly seen with a right lateral medullary (Wallenberg) Syndrome (ipsilesional hypermetric saccades can also be seen, but were not appreciated in her case). She was diagnosed with an MRI negative right medullary lesion, probably related to a stroke, and cardiac work-up to investigate a cardioembolic etiology was ordered
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Medullary structures relevant to upbeat nystagmus
Spencer S. Eccles Health Sciences Library University of Utah, 2017Co-Authors: Daniel R. Gold, Departments Of Neurology, Otolaryngology Head Neck - & Surgery, Emergency Medicine, And Medicine, The Johns Hopkins School Of MedicineAbstract:This is an axial section of the medulla, slightly more caudal as compared to (please refer to figure "medullary structures relevant to the ocular motor and vestibular consequences of the lateral medullary (Wallenberg) Syndrome). Again seen are the inferior cerebellar peduncle (ICP) and caudal aspect of the vestibular nucleus (medial vestibular nucleus [MVN]), in addition to the nucleus of Roller and nucleus intercalatus. These nuclei normally have an inhibitory influence over the flocculus, and when there is a lesion of Roller/intercalatus, there is less inhibition of the flocculus. The Purkinje cells of the flocculus normally inhibit the anti-gravity/anterior semicircular canal (SCC) pathways. With a lesion of Roller/intercalatus, the flocculus will over-inhibit the anterior SCC pathways, causing relative activation of the posterior SCC pathways which will generate a downward slow phase. The fast/position-reset phase will be upward, and these alternating slow (downward) and fast (upward) phases are responsible for upbeat nystagmus
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Saccadic pathways in the brainstem and cerebellum & mechanism for saccadic dysmetria in Wallenberg Syndrome - Normal function of the brainstem/cerebellar saccadic pathways
Spencer S. Eccles Health Sciences Library University of Utah, 2017Co-Authors: Daniel R. Gold, Departments Of Neurology, Otolaryngology Head Neck - & Surgery, Emergency Medicine, And Medicine, The Johns Hopkins School Of MedicineAbstract:The inferior cerebellar peduncle (ICP) carries climbing fibers to the dorsal vermis, and these fibers have an inhibitory influence over the Purkinje cells. These Purkinje cells normally inhibit the ipsilateral fastigial nucleus, and the fastigial nucleus projects to the contralateral inhibitory burst neurons (IBN) within the paramedian pontine reticular formation (PPRF). The IBN project contralaterally to inhibit the VIth nucleus to prevent unwanted saccades in this direction, while facilitating saccades (via the excitatory burst neurons [EBN]) in the opposite direction. Modified and redrawn with permission from Wolters Kluwer and the American Academy of Neurology. Frohman TC, Graves J, Balcer LJ, Galetta SL, Frohman EM. The neuro-ophthalmology of multiple sclerosis. Continuum (Minneap Minn) 2010;16:122-146
Caroline Tilikete - One of the best experts on this subject based on the ideXlab platform.
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Effects of structural and functional cerebellar lesions on sensorimotor adaptation of saccades
Experimental Brain Research, 2013Co-Authors: Muriel Panouilleres, Nadia Alahyane, Romeo Salemme, Christian Urquizar, Caroline Tilikete, Bertrand Gaymard, Norbert Nighoghossian, Denis PelissonAbstract:The cerebellum is critically involved in the adaptation mechanisms that maintain the accuracy of goal-directed acts such as saccadic eye movements. Two categories of saccades, each relying on different adaptation mechanisms, are defined: reactive (externally triggered) saccades and voluntary (internally triggered) saccades. The contribution of the medio-posterior part of the cerebellum to reactive saccades adaptation has been clearly demonstrated, but the evidence that other parts of the cerebellum are also involved is limited. Moreover, the cerebellar substrates of voluntary saccades adaptation have only been marginally investigated. Here, we addressed these two questions by investigating the adaptive capabilities of patients with cerebellar or pre-cerebellar stroke. We recruited three groups of patients presenting focal lesions located, respectively, in the supero-anterior cerebellum, the infero-posterior cerebellum and the lateral medulla (leading to a Wallenberg Syndrome including motor dysfunctions similar to those resulting from lesion of the medio-posterior cerebellum). Adaptations of reactive saccades and of voluntary saccades were tested during separate sessions in all patients and in a group of healthy participants. The functional lesion of the medio-posterior cerebellum in Wallenberg Syndrome strongly impaired the adaptation of both reactive and voluntary saccades. In contrast, patients with lesion in the supero-anterior part of the cerebellum presented a specific adaptation deficit of voluntary saccades. Finally, patients with an infero-posterior cerebellar lesion showed mild adaptation deficits. We conclude that the medio-posterior cerebellum is critical for the adaptation of both saccade categories, whereas the supero-anterior cerebellum is specifically involved in the adaptation of voluntary saccades.
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Saccadic lateropulsion in Wallenberg Syndrome: a window to access cerebellar control of saccades?
Experimental Brain Research, 2006Co-Authors: Caroline Tilikete, Norbert Nighoghossian, Ansgar Koene, Alain Vighetto, Denis PelissonAbstract:Saccadic lateropulsion is characterized by an undershoot of contralaterally directed saccades, an overshoot of ipsilaterally directed saccades and an ipsilateral deviation of vertical saccades. In Wallenberg Syndrome, it is thought to result from altered signals in the olivo-cerebellar pathway to the oculomotor cerebellar network. In the current study we aimed to determine whether saccadic lateropulsion results from a cerebellar impairment of motor related signals or visuo-spatial related signals. We studied the trajectory, the accuracy, the direction and the amplitude of a variety of vertical and oblique saccades produced by Wve patients and nine control subjects. Some results are consistent with previous data suggesting altered motor related signals. Indeed, the horizontal error of contralesional saccades in patients increased with the desired horizontal saccade size. Furthermore, the initial directional error measured during the saccadic acceleration phase was smaller than the global directional error, suggesting that the eye tra-jectory curved progressively. However, some other results suggest that the processes that specify the horizontal spatial goal of the saccades might be impaired in the patients. Indeed, the horizontal error of ipsilesional saccades in patients did not change signiWcantly with the desired horizontal saccade size. In addition, when comparing saccades with similar intended direction, it was found that the directional error was inversely related to the vertical saccade amplitude. Thus we conclude that the cerebellum might be involved both in controlling the motor execution of saccades and in determining the visuo-spatial information about their goal.
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otolith manifestations in Wallenberg Syndrome
Revue Neurologique, 2001Co-Authors: Caroline Tilikete, Norbert Nighoghossian, G Rode, D Boisson, A VighettoAbstract:Certaines manifestations neuro-otologiques du Syndrome de Wallenberg sont moins connues que la classique association de vertige, nystagmus et desequilibre en rapport avec une atteinte des voies vestibulaires centrales d'origine canalaire. Il s'agit de manifestations perceptives comme l'inclinaison de la verticale subjective et l'illusion de bascule de l'environnement, ou de manifestations oculomotrices comme la « skew deviation », la lateropulsion oculaire et le nystagmus de position, ou enfin de manifestations posturales comme la lateropulsion axiale. Nous rapportons une serie de 15 patients admis pour un Syndrome de Wallenberg presentant au moins un de ces signes ou symptomes neuro-otologiques non canalaires. Ces manifestations etaient definies cliniquement et documentees le cas echeant par des explorations instrumentales, a savoir un enregistrement des mouvements oculaires ou une etude posturographique. Ainsi, 11 patients presentaient une « skew deviation », 8 une inclinaison de la verticale subjective, 4 une illusion de bascule de l'environnement, 9 une lateropulsion axiale, 8 une lateropulsion oculaire et 3 un nystagmus de position central. A l'appui de notre etude et de resultats experimentaux anterieurs, nous suggerons que ces manifestations neuro-otologiques non canalaires, impliquent les voies vestibulaires ou vestibulo-cerebelleuses centrales transmettant des informations d'origine otolithique.
Norbert Nighoghossian - One of the best experts on this subject based on the ideXlab platform.
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Effects of structural and functional cerebellar lesions on sensorimotor adaptation of saccades
Experimental Brain Research, 2013Co-Authors: Muriel Panouilleres, Nadia Alahyane, Romeo Salemme, Christian Urquizar, Caroline Tilikete, Bertrand Gaymard, Norbert Nighoghossian, Denis PelissonAbstract:The cerebellum is critically involved in the adaptation mechanisms that maintain the accuracy of goal-directed acts such as saccadic eye movements. Two categories of saccades, each relying on different adaptation mechanisms, are defined: reactive (externally triggered) saccades and voluntary (internally triggered) saccades. The contribution of the medio-posterior part of the cerebellum to reactive saccades adaptation has been clearly demonstrated, but the evidence that other parts of the cerebellum are also involved is limited. Moreover, the cerebellar substrates of voluntary saccades adaptation have only been marginally investigated. Here, we addressed these two questions by investigating the adaptive capabilities of patients with cerebellar or pre-cerebellar stroke. We recruited three groups of patients presenting focal lesions located, respectively, in the supero-anterior cerebellum, the infero-posterior cerebellum and the lateral medulla (leading to a Wallenberg Syndrome including motor dysfunctions similar to those resulting from lesion of the medio-posterior cerebellum). Adaptations of reactive saccades and of voluntary saccades were tested during separate sessions in all patients and in a group of healthy participants. The functional lesion of the medio-posterior cerebellum in Wallenberg Syndrome strongly impaired the adaptation of both reactive and voluntary saccades. In contrast, patients with lesion in the supero-anterior part of the cerebellum presented a specific adaptation deficit of voluntary saccades. Finally, patients with an infero-posterior cerebellar lesion showed mild adaptation deficits. We conclude that the medio-posterior cerebellum is critical for the adaptation of both saccade categories, whereas the supero-anterior cerebellum is specifically involved in the adaptation of voluntary saccades.
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Saccadic lateropulsion in Wallenberg Syndrome: a window to access cerebellar control of saccades?
Experimental Brain Research, 2006Co-Authors: Caroline Tilikete, Norbert Nighoghossian, Ansgar Koene, Alain Vighetto, Denis PelissonAbstract:Saccadic lateropulsion is characterized by an undershoot of contralaterally directed saccades, an overshoot of ipsilaterally directed saccades and an ipsilateral deviation of vertical saccades. In Wallenberg Syndrome, it is thought to result from altered signals in the olivo-cerebellar pathway to the oculomotor cerebellar network. In the current study we aimed to determine whether saccadic lateropulsion results from a cerebellar impairment of motor related signals or visuo-spatial related signals. We studied the trajectory, the accuracy, the direction and the amplitude of a variety of vertical and oblique saccades produced by Wve patients and nine control subjects. Some results are consistent with previous data suggesting altered motor related signals. Indeed, the horizontal error of contralesional saccades in patients increased with the desired horizontal saccade size. Furthermore, the initial directional error measured during the saccadic acceleration phase was smaller than the global directional error, suggesting that the eye tra-jectory curved progressively. However, some other results suggest that the processes that specify the horizontal spatial goal of the saccades might be impaired in the patients. Indeed, the horizontal error of ipsilesional saccades in patients did not change signiWcantly with the desired horizontal saccade size. In addition, when comparing saccades with similar intended direction, it was found that the directional error was inversely related to the vertical saccade amplitude. Thus we conclude that the cerebellum might be involved both in controlling the motor execution of saccades and in determining the visuo-spatial information about their goal.
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otolith manifestations in Wallenberg Syndrome
Revue Neurologique, 2001Co-Authors: Caroline Tilikete, Norbert Nighoghossian, G Rode, D Boisson, A VighettoAbstract:Certaines manifestations neuro-otologiques du Syndrome de Wallenberg sont moins connues que la classique association de vertige, nystagmus et desequilibre en rapport avec une atteinte des voies vestibulaires centrales d'origine canalaire. Il s'agit de manifestations perceptives comme l'inclinaison de la verticale subjective et l'illusion de bascule de l'environnement, ou de manifestations oculomotrices comme la « skew deviation », la lateropulsion oculaire et le nystagmus de position, ou enfin de manifestations posturales comme la lateropulsion axiale. Nous rapportons une serie de 15 patients admis pour un Syndrome de Wallenberg presentant au moins un de ces signes ou symptomes neuro-otologiques non canalaires. Ces manifestations etaient definies cliniquement et documentees le cas echeant par des explorations instrumentales, a savoir un enregistrement des mouvements oculaires ou une etude posturographique. Ainsi, 11 patients presentaient une « skew deviation », 8 une inclinaison de la verticale subjective, 4 une illusion de bascule de l'environnement, 9 une lateropulsion axiale, 8 une lateropulsion oculaire et 3 un nystagmus de position central. A l'appui de notre etude et de resultats experimentaux anterieurs, nous suggerons que ces manifestations neuro-otologiques non canalaires, impliquent les voies vestibulaires ou vestibulo-cerebelleuses centrales transmettant des informations d'origine otolithique.
