Neurophysiological monitoring of brainstem function in a patient with Wallenberg syndrome, using Vestibular Evoked Myogenic Potentials.
OBJECTIVE
We evaluated the use of Vestibular Evoked Myogenic Potentials (VEMPs) in the assessment of neural function, following medullary lesions.


METHODS
A 54-year-old male presented with symptoms and signs typical of right lateral medullary (Wallenberg) syndrome. He underwent brain MRI and three successive neurophysiological investigations, which included VEMPs, Brainstem Auditory Evoked Responses (BAERs) and the blink reflex.


RESULTS
VEMPs amplitude on the left (unaffected) side was 256.8 microv in the first investigation and remained approximately equal to that value in the following two ones. Their amplitude on the right (affected) side was 37.9 microv, 154.2 microv and 235.2 microv correspondingly. At the same time vertigo, diplopia and nystagmus gradually improved. Right blink reflex comprised a normal R1, but delayed R2 ipsilateral and R2 contralateral responses, which remained unaltered during the follow-up period. Brain MRI disclosed a right dorsolateral medullary infarct.


CONCLUSIONS
VEMPs amplitude progressively increased, parallel to the improvement of vestibular symptoms. The blink reflex evolved differently, while BAERs were not affected. As the three evoked responses are mediated by separate neural circuits, they provide information on different aspects of brainstem function. Thus, VEMPs seem to be a useful method that complements existing ones in the assessment of brainstem lesions.
Deftereos
S N
SN
Neurology Department, Athens General Hospital, Mesogeion av, 11527, Athens, Greece. deftereo@otenet.gr
Panagopoulos
G
G
Gryllia
M
M
Georgonikou
D
D
Polyzoi
M
M
Kechagias
E
E
Aessopos
A
A
Karageorgiou
C E
CE
D000161:Acoustic Stimulation / Q000379:methods; D001933:Brain Stem / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology*; D004525:Efferent Pathways / Q000503:physiopathology; D004568:Electrodiagnosis / Q000295:instrumentation / Q000379:methods; D004576:Electromyography / Q000379:methods; D005071:Evoked Potentials / Q000502:physiology*; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D014854:Lateral Medullary Syndrome / Q000175:diagnosis* / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D009119:Muscle Contraction / Q000502:physiology; D009334:Neck Muscles / Q000294:innervation / Q000503:physiopathology; D011237:Predictive Value of Tests; D012444:Saccule and Utricle / Q000294:innervation / Q000502:physiology; D012680:Sensitivity and Specificity; D015837:Vestibular Diseases / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D014724:Vestibular Function Tests / Q000295:instrumentation / Q000379:methods*; D014725:Vestibular Nerve / Q000502:physiology; D014726:Vestibular Nuclei / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology*