Neurological disturbances, blink reflex responses, outcome, and associated lesions of 15 patients with infarction of the lower brain stem. Patients with normal blink reflexes (1–5) more often had an incomplete Wallenberg’s syndrome (WS) than patients with loss or delay of R2-i/R2c-i (no 6–13). According to the outcome there was no significant difference between the two groups
Patient | WS signs2-150 | Additional signs | Blink reflex2-151 | Outcome2-152 | Associated lesions | |||||
---|---|---|---|---|---|---|---|---|---|---|
1 | 1, 2, 3, 4, 5, 6 | Contralateral. hemiparesis | Normal | 5 | PCA, cerebellum, and supratentorial vascular encephalopathy | |||||
Complete | ||||||||||
2 | 2, 3, 6 | No | Normal | 2 | No | |||||
Incomplete | ||||||||||
3 | 1, 2, 3, 4, 6 | Transient ipsilat. Facial weakness with sparing the upper face, skew deviation | Normal | 3 | Old lesions: MCA, basal ganglia, cerebellum | |||||
Complete | ||||||||||
4 | 1, 3, 4 | No | Normal | 2 | No | |||||
Incomplete | ||||||||||
5 | 3, 4 | No | Normal | x | No | |||||
incomplete | ||||||||||
6 | 1, 2, 3, 5, 6 | Ipsilateral facial weakness with sparing the upper face | R1-i slightly delayed (12,1 ms), loss of R2-i /R2c-i | 5 | Old lesion: MCA | |||||
complete | ||||||||||
7 | 1, 2, 4, 6 | Skew deviation | R2-i side difference (not significant), R2c-i side difference | 1 | No | |||||
complete | ||||||||||
8 | 1, 2, 3, 4, 6 | Skew deviation | R2-i/R2c-i side difference | 3 | No | |||||
complete | ||||||||||
9 | 1, 2, 3, 4, 5, 6 | No | R2-i/R2c-i delayed | 3 | Cerebellum | |||||
complete | ||||||||||
10 | 1, 2, 3, 4, 5, 6 | No | Loss of R2-i/R2c-i | 4 | Cerebellum | |||||
complete | ||||||||||
11 | 1, 2, 3, 4, 5, 6 | Transient ipsilateral facial weakness with sparing the upper face | R2-i/R2c-i delayed | 4 | Cerebellum | |||||
complete | ||||||||||
12 | 1, 2, 3, 4, 5, 6 | No | Loss of R2-i/R2c-i, loss of R2c-c | 4 | Cerebellum | |||||
complete | ||||||||||
13 | 1, 3, 5, 6 | Skew deviation | Loss of R2-i/R2c-i | 4 | Cerebellum | |||||
complete | ||||||||||
14 | 2, 6 | Ipsilateral facial weakness of peripheral type, skew deviation | R2-i delayed, R2c-c side difference (not significant) | 3 | No | |||||
incomplete | ||||||||||
15 | 1, 2, 3, 4, 5, 6 | Ipsilateral facial weakness with sparing the upper face, skew deviation | Loss of R2-i/R2c-i, loss of R2-c/R2c-c | 6 | Old lesion: basal ganglia | |||||
complete |
↵2-150 1=Ipsilateral Horner’s sign; 2=ipsilateral impairment of facial pain and/or temperature sensation; 3=palsy of cranial nerve IX and/or X; 4=contralateral impairment of pain and temperature sensation over trunk and limbs; 5=ipsilateral limb dysmetria; 6=astasia and gait ataxia.
↵2-151 R1-i=R1 to stimulation ipsilaterally to lesion; R1-c=R1 to stimulation contralaterally to lesion; R2-i=R2 to stimulation ipsilaterally to lesion; R2-c=R2 to stimulation contralaterally to lesion; R2c-i=R2c to stimulation ipsilaterally to lesion; R2c-c=R2c to stimulation contralaterally to lesion.
↵2-152 Outcome at time of discharge from neurological ward (modified Rankin scale): 0=no symptoms at all; 1=no significant disability despite symptoms; 2=slight disability; unable to carry out all previous activities but able to look after own affairs without assistance; 3=moderate disability; requiring some help; but able to walk without assistance; 4=moderately severe disability; unable to walk without assistance; and unable to attend to own bodily needs without assistance; 5=severe disability; bedridden; incontinent; and requiring constant nursing care and attention; 6=death; x=no acute infarction