title: Diagnostic value of vestibular evoked myogenic potentials in cerebellar and lower-brainstem strokes.
abstract: BACKGROUND
  Vestibular evoked myogenic potentials (VEMPs) provide assessment of vestibular function. They consist in picking up compound muscle action potentials in the sternocleidomastoid (SCM) muscles in response to auditory stimulation of the vestibulum. VEMP testing has found application mainly in peripheral vestibular disorders, whereas reports about VEMPs in central vestibular lesions are rather scarce.
  
  
  OBJECTIVE
  Based on the physiological connections between the cerebellum and the vestibular nuclei, we investigated the influence on VEMPs of cerebellar and lower-brainstem strokes. We examined whether or not this method may be suitable as a clinical tool for the evaluation of the extent of cerebellar strokes.
  
  
  METHODS
  Nineteen patients with cerebellar ischemic stroke and 15 patients with lower-brainstem ischemic stroke (11 in the pons, four in the medulla) were included. The latencies and amplitudes of P13 and N23 in both groups of patients were compared with those obtained in a control group of 53 normal individuals.
  
  
  RESULTS
  VEMP responses were obtained in all patients and controls. At the group level, mean peak latencies and amplitudes, and the number of subjects with significantly deviant values did not differ between patients and controls. There were no latency or amplitude differences ipsilaterally or contralaterally to the lesion. At the individual level, there was no correlation between laterality of lesion and that of P13 or N23 abnormalities in patients with cerebellar strokes; however, there were two patients (one pontine, one medullar stroke) who presented P13 and N23 latency abnormalities ipsilaterally to the lesion.
  
  
  CONCLUSIONS
  Cerebellar strokes do not influence VEMPs. Moreover, despite previous reports, we were unable to find at a group level any statistically significant VEMP changes in patients with lower-brainstem strokes as compared with controls. Therefore, VEMPs do not appear a suitable tool for assessment of brainstem integrity in patients with posterior fossa strokes. However, they could constitute a sensitive method for documentation of involvement of the central vestibular pathways in patients with brainstem stroke.
authors.affiliation: Department of Neurology, The Assaf Harofeh Medical Center, Zerifin, Israel; Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. lea.pollak@gmail.com
authors.forename: L
authors.initials: L
authors.lastname: Pollak
authors.forename: M
authors.initials: M
authors.lastname: Kushnir
authors.forename: R
authors.initials: R
authors.lastname: Stryjer
mesh_terms: D000161:Acoustic Stimulation; D020526:Brain Stem Infarctions / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D002526:Cerebellar Diseases / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D003388:Cranial Fossa, Posterior / Q000473:pathology; D005071:Evoked Potentials / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D011149:Pons / Q000473:pathology; D020521:Stroke / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D014722:Vestibule, Labyrinth / Q000502:physiology*