Altered Processing of Complex Visual Stimuli in Patients with Postconcussive Visual Motion Sensitivity

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FIG 1.
fMRI visual-vestibular paradigm group results. Group mean activation for provocative-neutral contrast in control subjects (A) and patients with PCVMS (B). Widespread activation is seen in the bilateral occipital lobe primary and secondary visual areas, parietal lobes, PIVC, frontal lobes in the region of the FEF, and cingulate gyri.
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FIG 2.
fMRI visual-vestibular paradigm PCVMS results. Selective increased activation was demonstrated in the PCVMS>control group for provocative-neutral contrast in several regions, including the opercular cortex, insular cortex, inferior and middle temporal gyri, precentral gyrus, inferior frontal gyrus, and supramarginal gyrus.

Table 1:

Clinical testing in patients with PCVMS and control subjects^{^a}

	Concussed Patients	Control Subjects	P Value^{^b}
Subjective measurements
PCSS	37.93 (SD, 26.61)	0.14 (SD, 0.38)	.002
DHI	44 (SD, 17.9)	0 (SD, 0)	<.001
VVAS	24.47 (SD, 28.28)	1.20 (SD, 2.10)	<.001
VOMS domain^{^c}
Smooth pursuit	0.52 (SD, 0.92)	0.00 (SD, 0.00)	.003
Horizontal saccade	0.50 (SD, 1.03)	0.03 (SD, 0.16)	.004
Vertical saccade	0.77 (SD, 1.36)	0.00 (SD, 0.00)	<.001
Convergence	2.02 (SD, 2.42)	0.00 (SD, 0.00)	<.001
Horizontal vestibular ocular reflex	1.29 (SD, 1.69)	0.20 (SD, 0.76)	<.001
Vertical vestibular ocular reflex	1.13 (SD, 1.71)	0.08 (SD, 0.35)	<.001
Visual motion sensitivity	1.25 (SD, 1.97)	0.03 (SD, 0.16)	.002
Near point of convergence distance (cm)	7.74 (SD, 7.20)	2.47 (SD, 1.76)	.019
Objective measurements
BESS	17.9 (SD, 7.35)	13.7 (SD, 4.8)	.170
Drop stick reaction time	215.6 (SD, 18.4)	184.9 (SD, 56.9)	.096

Table 2:

Correlation between fMRI brain activation and VOMS testing scores in patients with PCVMS and control subjects

ROI/VOMS Domain	R (10)^{^a}	95% CI	P Value
Left FEF
Δ aggregate	0.583	0.014–0.867	.047
Smooth pursuit	0.608	0.052–0.876	.036
Δ smooth pursuit	0.684	0.183–0.904	.014
Horizontal saccade	0.578	0.001–0.865	.049
Δ horizontal saccade	0.722	0.253–0.916	.008
Δ vertical saccade	0.695	0.201–0.907	.012
Vertical vestibular-ocular reflex	0.694	0.200–0.907	.012
Δ vertical vestibular-ocular reflex	0.645	0.113–0.890	.024
Δ horizontal vestibular-ocular reflex	0.584	0.015–0.867	.046
Right posterior hippocampus
Δ smooth pursuit	0.609	0.054–0.877	.036
Δ horizontal saccade	0.638	0.101–0.887	.026
Δ vertical saccade	0.599	0.038–0.873	.040
Left MT/V5
Vertical vestibular-ocular reflex	0.723	0.254–0.916	.008

Note:—Δ indicates the difference in scores between the initial and provocative testing portions of VOMS; Aggregate, the sum of all VOMS symptoms scores.
↵a Pearson correlation coefficient.