Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1999 Nov;67(5):630–636. doi: 10.1136/jnnp.67.5.630

Blink reflex R2 changes and localisation of lesions in the lower brainstem (Wallenberg's syndrome): an electrophysiological and MRI study

S Fitzek 1, C Fitzek 1, J Marx 1, H Speckter 1, P Urban 1, F Thomke 1, P Stoeter 1, H Hopf 1
PMCID: PMC1736618  PMID: 10519870

Abstract

OBJECTIVES—Pathways of late blink reflexes are detected by high resolution MRI. Electronically matched stroke lesions superimposed to an anatomical atlas show the suspected course.
METHODS—Fifteen patients with infarction of the lower brainstem, MRI lesions and electrically elicited blink reflexes were examined. The involved structures in patients with R2 and R2c blink reflex changes were identified by biplane high resolution MRI with individual slices matched to an anatomical atlas at 10 different levels using digital postprocessing methods.
RESULTS—The blink reflexes were normal in five of 15 patients (33%) and showed loss or delay of R2 and R2c to stimulation ipsilaterally to lesion (R2-i and R2c-i) in eight (53%). Loss or delay of R2-i/R2c-i was seen in lesions covering the entire trigeminal spinal tract and nucleus (TSTN) at at least one level. These infarctions were located more dorsally within the medulla. Patients with normal blink reflexes showed lesions sparing or involving the TSTN only partially. They more often had incomplete Wallenberg's syndromes and MRI lesions were located more ventrally.
CONCLUSIONS—Using digital postprocessing MRI methods it was possible to identify central pathways of late blink reflex in patients with Wallenberg's syndrome. This method is suggested as a new approach to identify incompletely understood functional structures of the brainstem.



Full Text

The Full Text of this article is available as a PDF (261.1 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aramideh M., Ongerboer de Visser B. W., Koelman J. H., Majoie C. B., Holstege G. The late blink reflex response abnormality due to lesion of the lateral tegmental field. Brain. 1997 Sep;120(Pt 9):1685–1692. doi: 10.1093/brain/120.9.1685. [DOI] [PubMed] [Google Scholar]
  2. CURRIER R. D., GILES C. L., DEJONG R. N. Some comments on Wallenberg's lateral medullary syndrome. Neurology. 1961 Sep;11:778–791. doi: 10.1212/wnl.11.9.778. [DOI] [PubMed] [Google Scholar]
  3. Celik M., Forta H. Electrophysiological investigations and prognosis in idiopathic facial palsy. Electromyogr Clin Neurophysiol. 1997 Aug;37(5):311–315. [PubMed] [Google Scholar]
  4. Chia L. G., Shen W. C. Wallenberg's lateral medullary syndrome with loss of pain and temperature sensation on the contralateral face: clinical, MRI and electrophysiological studies. J Neurol. 1993 Sep;240(8):462–467. doi: 10.1007/BF00874113. [DOI] [PubMed] [Google Scholar]
  5. Cox R. W. AFNI: software for analysis and visualization of functional magnetic resonance neuroimages. Comput Biomed Res. 1996 Jun;29(3):162–173. doi: 10.1006/cbmr.1996.0014. [DOI] [PubMed] [Google Scholar]
  6. Dieterich M., Brandt T. Wallenberg's syndrome: lateropulsion, cyclorotation, and subjective visual vertical in thirty-six patients. Ann Neurol. 1992 Apr;31(4):399–408. doi: 10.1002/ana.410310409. [DOI] [PubMed] [Google Scholar]
  7. FISHER C. M., KARNES W. E., KUBIK C. S. Lateral medullary infarction-the pattern of vascular occlusion. J Neuropathol Exp Neurol. 1961 Jul;20:323–379. doi: 10.1097/00005072-196107000-00001. [DOI] [PubMed] [Google Scholar]
  8. Goor C., Pngerboer De Visser B. W. Jaw and blind reflexes in trigeminal nerve lesions. An electrodiagnostic study. Neurology. 1976 Jan;26(1):95–97. doi: 10.1212/wnl.26.1.95. [DOI] [PubMed] [Google Scholar]
  9. Hiraoka M., Shimamura M. Neural mechanisms of the corneal blinking reflex in cats. Brain Res. 1977 Apr 15;125(2):265–275. doi: 10.1016/0006-8993(77)90620-5. [DOI] [PubMed] [Google Scholar]
  10. Hopf H. C., Thömke F., Gutmann L. Midbrain vs. pontine medial longitudinal fasciculus lesions: the utilization of masseter and blink reflexes. Muscle Nerve. 1991 Apr;14(4):326–330. doi: 10.1002/mus.880140406. [DOI] [PubMed] [Google Scholar]
  11. Hopf H. C. Topodiagnostic value of brain stem reflexes. Muscle Nerve. 1994 May;17(5):475–484. doi: 10.1002/mus.880170502. [DOI] [PubMed] [Google Scholar]
  12. Kimura J. Electrically elicited blink reflex in diagnosis of multiple sclerosis. Review of 260 patients over a seven-year period. Brain. 1975 Sep;98(3):413–426. doi: 10.1093/brain/98.3.413. [DOI] [PubMed] [Google Scholar]
  13. Kimura J., Lyon L. W. Orbicularis oculi reflex in the Wallenberg syndrome: alteration of the late reflex by lesions of the spinal tract and nucleus of the trigeminal nerve. J Neurol Neurosurg Psychiatry. 1972 Apr;35(2):228–233. doi: 10.1136/jnnp.35.2.228. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Meincke U., Ferbert A. Blink reflex in patients with an ischaemic lesion of the brain-stem verified by MRI. J Neurol. 1993 Nov;241(1):37–44. doi: 10.1007/BF00870670. [DOI] [PubMed] [Google Scholar]
  15. Ongerboer de Visser B. W. Comparative study of corneal and blink reflex latencies in patients with segmental or with cerebral lesions. Adv Neurol. 1983;39:757–772. [PubMed] [Google Scholar]
  16. Ongerboer de Visser B. W., Kuypers H. G. Late blink reflex changes in lateral medullary lesions. An electrophysiological and neuro-anatomical study of Wallenberg's Syndrome. Brain. 1978 Jun;101(2):285–294. doi: 10.1093/brain/101.2.285. [DOI] [PubMed] [Google Scholar]
  17. Sacco R. L., Freddo L., Bello J. A., Odel J. G., Onesti S. T., Mohr J. P. Wallenberg's lateral medullary syndrome. Clinical-magnetic resonance imaging correlations. Arch Neurol. 1993 Jun;50(6):609–614. doi: 10.1001/archneur.1993.00540060049016. [DOI] [PubMed] [Google Scholar]
  18. Tackmann W., Ettlin T., Barth R. Blink reflexes elicited by electrical, acoustic and visual stimuli. I. Normal values and possible anatomical pathways. Eur Neurol. 1982;21(3):210–216. doi: 10.1159/000115483. [DOI] [PubMed] [Google Scholar]
  19. Vallis-Solé J., Vila N., Obach V., Alvarez R., González L. E., Chamorro A. Brain stem reflexes in patients with Wallenberg's syndrome: correlation with clinical and magnetic resonance imaging (MRI) findings. Muscle Nerve. 1996 Sep;19(9):1093–1099. doi: 10.1002/(SICI)1097-4598(199609)19:9<1093::AID-MUS3>3.0.CO;2-V. [DOI] [PubMed] [Google Scholar]
  20. Vila N., Valls-Solé J., Obach V., Sáiz A., Alday M., Chamorro A. Blink reflex in patients with Wallenberg's syndrome. J Neurol. 1997 Jan;244(1):30–34. doi: 10.1007/pl00022908. [DOI] [PubMed] [Google Scholar]
  21. Vuilleumier P., Bogousslavsky J., Regli F. Infarction of the lower brainstem. Clinical, aetiological and MRI-topographical correlations. Brain. 1995 Aug;118(Pt 4):1013–1025. doi: 10.1093/brain/118.4.1013. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES