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Blink reflex in patients with an ischaemic lesion of the brain-stem verified by MRI

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Abstract

The electrically elicited blink reflex was investigated in 25 patients with ischaemic lesions of the pons or the medulla oblongata. Only patients with a lesion on MRI appropriate to the clinical syndrome were included. Twenty patients had an infarction of the pons, bilateral in 5. Additional 5 patients had an infarction of the dorsolateral medulla oblongata. Patients with hemispheric lesions were excluded. Four of the 5 patients with Wallenberg's syndrome showed delayed R2 components to stimulation ipsilateral to the lesion. Additional loss of the ipsilateral R1 component was observed in 1 patient. Fifteen of the 20 patients with pontine infarctions had pathological blink reflexes. All 6 patients with a unilateral pons lesion and an abnormality of R1 had this abnormality on the side contralateral to the lesion. In 3 cases with bilateral pontine infarction R1 was abnormal on one side or on either side. Of 11 patients with a normal R1, 6 had isolated abnormalities of R2 without consistent correlation to the side of the lesion. We conclude that abnormalities of the blink reflex are of minor localizing value in pontine infarction. This may be explained by the fact that a pontine infarction affects either the reflex arch itself or descending pathways that have a modulating influence on the reflex arch. Infarctions of the medulla oblongata, however, have characteristic abnormalities that have already been described.

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References

  1. Berardelli A, Accornero N, Cruccu G, Fabiano F, Guerrisi V, Manfredi M (1983) The orbicularis oculi response after hemispheral damage. J Neurol Neurosurg Psychiatry 46:837–843

    PubMed  Google Scholar 

  2. Bogousslavsky J, Fox AJ, Barnett HJM, Hachinski VC, Vinitski S, Carey LS (1986) Clinico-topographic correlation of small vertobobasilar infarct using magnetic resonance imaging. Stroke 17:929–938

    PubMed  Google Scholar 

  3. Ferbert A, Vielhaber S, Meincke U, Buchner H (1992) Transcranial magnetic stimulation in pontine infarction: correlation to degree of paresis. J Neurol Neurosurg Psychiatry 55:294–299

    PubMed  Google Scholar 

  4. Fisher CM (1987) Lateral medullary infarction extending to the lower pons. J Neurol Neurosurg Psychiatry 50:620–624

    PubMed  Google Scholar 

  5. Fisher CM, Karnes WE, Kubik S (1961) Lateral medullary infarction: the pattern of vascular occlusion. J Neuropathol Exp Neurol 20:323–379

    PubMed  Google Scholar 

  6. Hacke W, Schaff C, Zeumer H (1983) Der Orbicularis-oculi-Reflex bei computertomographisch verifizierten Lä sionen der hinteren Schä3delgrube. Fortschr Neurol Psychiatr 51:313–324

    PubMed  Google Scholar 

  7. Kaplan PE, Kaplan C (1980) Review of methodology and its application to patients with stroke syndromes. Arch Phys Med Rehabil 61:30–33

    PubMed  Google Scholar 

  8. Kimura J (1970) Alterations of the orbicularis oculi reflex by pontine lesions. Study in multiple sclerosis. Arch Neurol 22:156–161

    PubMed  Google Scholar 

  9. Kimura J (1971) Electrodiagnostic study of brainstem strokes. Stroke 2:576–586

    PubMed  Google Scholar 

  10. Kimura J (1975) Electrically elicited blink reflex in diagnosis of multiple sclerosis. Review of 260 patients over a seven-year period. Brain 98:413–426

    PubMed  Google Scholar 

  11. Kimura J, Lyon LW (1972) Orbicularis oculi reflex in Wallenberg syndrome: alteration of the late reflex by lesions of the spinal tract and nucleus of the trigeminal nerve. J Neurol Neurosurg Psychiatry 35:228–233

    PubMed  Google Scholar 

  12. Kimura J, Wilkinson JT, Damasio H, Adams HR, Shivapour E, Yamada T (1985) Blink reflex in patients with hemispheric cerebrovascular accident (CVA). J Neurol Sci 67:15–28

    Article  PubMed  Google Scholar 

  13. Kuypers HGJM (1958) Corticobulbar connexions to the pons and lower brain-stem in man. Brain 81:364–388

    PubMed  Google Scholar 

  14. amerow NS, Etemadi A (1970) Orbicularis oculi reflex in multiple sclerosis. Neurology 20:1200–1203

    PubMed  Google Scholar 

  15. Ongerboer de Visser BW (1983) Comparative study of corneal and blink latencies in patients with segmental or with cerebral lesions. In: Desmedt JE (ed) Motor control mechanisms in health and disease. Raven Press, New York, pp 757–772

    Google Scholar 

  16. Ongerboer de Visser BW, Kuypers HGJM (1978) Late blink reflex changes in lateral medullary lesions: an electrophysiological and neuroanatomical study of Wallenberg's syndrome. Brain 101:285–294

    PubMed  Google Scholar 

  17. Ongerboer de Visser BW, Cruccu G, Manfredi M, Koelman JHTH (1989) Effects of brainstem lesions on the masseter inhibitory reflex. Brain 113:781–792

    Google Scholar 

  18. Ross MA, Biller J, Adams HP, Dunn V (1986) Magnetic resonance imaging in Wallenberg's lateral medullary syndrome. Stroke 17:542–545

    PubMed  Google Scholar 

  19. Uncini A, Faricelli A, Assetta M, Serio A, Tartaro A, Gambi D (1990) Electrophysiological and magnetic resonance imaging correlates of brainstem demyelinating lesions. Electromyogr Clin Neurophysiol 30:233–238

    Google Scholar 

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Meincke, U., Ferbert, A. Blink reflex in patients with an ischaemic lesion of the brain-stem verified by MRI. J Neurol 241, 37–44 (1993). https://doi.org/10.1007/BF00870670

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  • DOI: https://doi.org/10.1007/BF00870670

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