J Neurol Neurosurg Psychiatry 1999;67:390-394 ( September )

Short report

A case of thalamic syndrome: somatosensory influences on visual orientation D Anastasopoulos, A M Bronstein

MRC Human Movement and Balance Unit, Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK

Correspondence to: Dr AM Bronstein, MRC Human Movement and Balance Unit, Institute of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK. Fax 0044 171 837 7281; email DIZZYMRC{at}ION.UCL.AC.UK

Received 20 October 1998 and in revised form 7 April 1999; Accepted 13 April 1999

The ability to set a straight line to the perceived gravitational vertical (subjective visual vertical, SVV) was investigated in a 21 year old woman with long standing left hemihypaesthesia due to a posterior thalamic infarct. The putative structures involved were the somatosensory and vestibular thalamus (VPL, VPM) and associative (pulvinar) thalamus. The SVV was normal when seated upright. When lying on her right side, line settings deviated about 17° to the right, which is the normal A-effect. When lying on the hypaesthetic side the mean SVV remained close to true verticalthat is, the A-effect was absent, and there was a large increase in variability of the SVV settings. The findings support the view that the body tilt-induced bias of the SVV (A-effect) is largely mediated by somatosensory afferents. The finding that the A-effect was absent only when lying on the hypaesthetic side suggests that, during body tilt, the somatosensory system participates in visuogravitational orientation.


Keywords: spatial orientation; visual vertical; somatosensory system; graviception

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© 1999 by Journal of Neurology, Neurosurgery, and Psychiatry
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