Changes of visual vertical perception: A long-term sign of unilateral and bilateral vestibular loss

This study investigates how unilateral and bilateral vestibular deafferentation modifies visual vertical perception in the presence of dynamic and static visual cues. We tested 40 Menière's patients before and after (from 1 week to 1 year) a curative unilateral vestibular neurotomy (UVN), and 4 patients with bilateral vestibular loss. Patients’ performances were compared with those of 24 healthy subjects. The perception of the dynamic visual vertical (DVV) was investigated during optokinetic stimulations around the line of sight at various angular velocities. The static visual vertical (SVV) was recorded with a stationary visual pattern. In the acute stage after UVN, Menière's patients exhibited drastic impairment of DVV, which was tilted towards the lesioned side, whatever the direction of the optokinetic stimulation. In addition, the SVV was systematically tilted towards the lesioned side. The optokinetic-induced tilt of the vertical was asymmetrically organized around the new SVV with a significant decrease for contralesional stimulations and no change for ipsilesional stimulations, whatever the postoperative time. The SVV regained normal values 1 year postoperatively. For the patients with bilateral vestibular loss, the optokinetic-induced tilt of the visual vertical was drastically increased and symmetrically organized around an unmodified SVV aligned with the gravitational vertical. This study constitutes the first description of the recovery time-course of DVV perception after unilateral vestibular loss. Data reveal a long-term impairment of the DVV perception after unilateral vestibular loss, suggesting an asymmetrical processing of visual information and a permanent increased weight of dynamic visual cues after bilateral vestibular loss.