Vertigo and anxiety are frequent symptoms in both psychiatric and vertigo patients, especially in those with phobic postural vertigo (PPV). The aim of this study was the investigation of anxiety-associated functional responses in PPV patients compared to healthy controls. For that purpose cholecystokinin tetrapeptide (CCK-4), a valid model to experimentally induce anxiety symptoms, was used.

15 PPV patients and 15 matched healthy controls underwent challenges with CCK-4. During the paradigm, participants did not know the exact time point of the injection in order to separate the anticipatory and CCK-4 induced anxiety. The panic symptom scale score was assessed before and after the injection.

During anticipatory anxiety healthy controls showed functional responses mainly in fronto-temporal regions. Patients suffering from PPV showed pronounced BOLD responses in the (ventral) anterior cingulate cortex (ACC), dorsolateral prefrontal cortex, orbitofrontal cortex and precuneus. In healthy subjects, CCK-4 induced anxiety was accompanied by activations in the medial and inferior frontal cortex. In PPV, the CCK-4 injection led to increased activities particularly in the ACC, the cuneus, the cerebellum, the amygdala and fronto-temporal regions.

Given the fact of increased neuronal responses in emotion-related brain areas in patients with anxiety disorders these findings could provide evidence for common aspects of phobic postural vertigo and anxiety disorders.