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Vestibular and visual cortex activity during room tilt illusion

J Neurol. 2017 Mar 21. doi: 10.1007/s00415-017-8457-4. [Epub ahead of print]

Authors/Editors: Kirsch V, Keeser D, Becker-Bense S, Karali T, Ertl-Wagner B, Brandt T, Dieterich M.
Publication Date: 2017



A sudden attack of transient upside-down inversion of vision is called a room tilt illusion (RTI), a rare clinical syndrome caused by false cortical integration of vestibular and visual cues for the perception of verticality. Usually, this mismatch of the cortical visual and vestibular 3D coordinate maps is caused by an acute vestibular tone imbalance. The patient experiences either paroxysmal 90° tilts of the visual scene or 180° (“upside-down”) vision without any alteration of the object’s color, shape, or size. RTI occurs in various peripheral (bilateral vestibular failure, Méniere’s disease) and central vestibular disorders, most notably in patients with lower brainstem infarctions, cortical lesions, or vestibular epilepsy. The particular role that the visual and vestibular cortices and their intrahemispheric and transhemispheric interactions play in the pathophysiological mechanism remains unclear. We investigated this question in a patient who could voluntarily elicit repetitive, clockwise 90° tilts (perceived image tilted to the right) while lying in a magnetic resonance (MR) scanner.

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