Anatomic and Physiologic Properties and Clinical Manifestations ofVestibulo-Autonomic Reflexes

The vestibular nervous system senses linear and angular acceleration upon the head during postural change and generates vestibular nerve activity changes. The autonomic nervous system regulates involuntary physiologic processes throughout the peripheral and central nervous systems. The vestibular and autonomic systems interplay throughout several brain regions to maintain homeostasis during the postural changes, called vestibulo-autonomic reflex. In this review, we first contemplated the anatomic and physiologic properties of vestibulo-autonomic reflex, focusing on the relationship between vestibular and cardiovascular systems and between the vestibular and respiratory systems and the role of the brainstem and cerebellum on the vestibulo-autonomic reflex. Then, we summarized the autonomic dysfunction reported in patients with various vestibular disorders, such as acute unilateral vestibulopathy, benign paroxysmal positional vertigo, Meniere’s disease, and persistent perceptual postural dizziness. Finally, we described the mechanism of autonomic manifestation in vestibular disorders in detail using the recently proposed mechanism of vestibular syncope integrating the vestibular system, brainstem and cerebellum, and autonomic system functions.