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a Department
of Neurology University of Mainz, Germany, b Institute of Neuroradiology,
University of Mainz, Germany, c Department
of Neurology, University of Jena, Germany
Correspondence to: Dr Sabine Fitzek, Department of Neurology, University of Jena, Philosophenweg 3, D-07740 Jena, Germany.
Received 5 January
1999 and in revised form 15 April 1999;
Accepted 9 June
1999
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.
METHODSFifteen
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.
RESULTSThe 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.
CONCLUSIONSUsing
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.
This article has been cited by other articles:
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  G. Cruccu, G. D. Iannetti, J. J. Marx, F. Thoemke, A. Truini, S. Fitzek, F. Galeotti, P. P. Urban, A. Romaniello, P. Stoeter, et al. Brainstem reflex circuits revisited Brain, February 1, 2005; 128(2): 386 - 394. [Abstract] [Full Text] [PDF]
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 J J Marx, G D Iannetti, A Mika-Gruettner, F Thoemke, S Fitzek, G Vucurevic, P P Urban, P Stoeter, G Cruccu, and H C Hopf Topodiagnostic investigations on the sympathoexcitatory brain stem pathway using a new method of three dimensional brain stem mapping J. Neurol. Neurosurg. Psychiatry, February 1, 2004; 75(2): 250 - 255. [Abstract] [Full Text] [PDF]
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 J. H. Jaster, S. Fitzek, C. Fitzek, T. W. Smith, and T. Becske Myocardial injury after hemorrhage into the lateral medulla oblongata Neurology, September 25, 2001; 57(6): 1145 - 1145. [Full Text] [PDF]
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J H JASTER Postictal psychosis related regional cerebral hyperfusion. J. Neurol. Neurosurg. Psychiatry, January 1, 2001; 70(1): 137 - 138. [Full Text]
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