[Chiari II Malformation. Supportive and Predictive Value of Brainstem Reflex and EAEP Recordings]

Overview

Journal Nervenarzt

Specialty Neurology

Date 2010 Jan 27

PMID 20101490

Authors

J Koehler

J Eggers

M Schwarz

A Faldum

Affiliations

Soon will be listed here.

Abstract

Background: In about 20% of patients with Chiari II malformation brainstem signs and symptoms occur. Ventilatory dysfunction is the main cause of death in these patients. The indication for craniocervical decompression is based on clinical examination because supporting electrophysiological or radiological methods were lacking.

Methods: In a prospective study the clinical courses of 106 patients were documented during a 3-year period. In addition brainstem diagnostic procedures using the masseter reflex (MR), blink reflex (BR) and early auditory evoked potentials (EAEP) were done. Based on the model of binary logistic regression the odds ratio (OR) of progression over time was calculated.

Results: The combination of MR and late BR components showed the highest correlation with clinical findings (OR: 23). The highest predictive value regarding clinical progression over a 3-year period was shown by the combined evaluation of MR, late BR components and EAEP interpeak latency I-V (OR: 17.6). Signs and symptoms had no predictive value.

Conclusions: Combined brainstem reflex recordings (MR and late BR components) support the clinical examination. To evaluate the long-term prognosis brainstem reflexes and EAEP recordings should be used.

References

Curnes J, Oakes W, Boyko O . MR imaging of hindbrain deformity in Chiari II patients with and without symptoms of brainstem compression. AJNR Am J Neuroradiol. 1989; 10(2):293-302. PMC: 8331390. View

Koehler J, Schwarz M, Boor R, Holker C, Hopf H, VOTH D . Assessment of brainstem function in Chiari II malformation utilizing brainstem auditory evoked potentials (BAEP), blink reflex and masseter reflex. Brain Dev. 2000; 22(7):417-20. DOI: 10.1016/s0387-7604(00)00162-5. View

Hopf H . Topodiagnostic value of brain stem reflexes. Muscle Nerve. 1994; 17(5):475-84. DOI: 10.1002/mus.880170502. View

Docherty T, Herbaut A, Sedgwick E . Brainstem auditory evoked potential abnormalities in myelomeningocoele in the older child. J Neurol Neurosurg Psychiatry. 1987; 50(10):1318-22. PMC: 1032458. DOI: 10.1136/jnnp.50.10.1318. View

Pollack I, Pang D, Albright A, Krieger D . Outcome following hindbrain decompression of symptomatic Chiari malformations in children previously treated with myelomeningocele closure and shunts. J Neurosurg. 1992; 77(6):881-8. DOI: 10.3171/jns.1992.77.6.0881. View

Koehler J, Holker C . Masseter reflex in childhood and adolescence. Pediatr Neurol. 2004; 30(5):320-3. DOI: 10.1016/j.pediatrneurol.2003.10.011. View

de la Cruz R, Millan J, Miralles M, Munoz M . Cranial sonographic evaluation in children with meningomyelocele. Childs Nerv Syst. 1989; 5(2):94-8. DOI: 10.1007/BF00571117. View

Hopf H, Hinrichs C, Stoeter P, Urban P, Marx J, Thomke F . Masseter reflex latencies and amplitudes are not influenced by supratentorial and cerebellar lesions. Muscle Nerve. 1999; 23(1):86-9. DOI: 10.1002/(sici)1097-4598(200001)23:1<86::aid-mus11>3.0.co;2-m. View

Eisenstat D, Bernstein M, FLEMING J, Vanderlinden R, Schutz H . Chiari malformation in adults: a review of 40 cases. Can J Neurol Sci. 1986; 13(3):221-8. DOI: 10.1017/s0317167100036313. View

10.

McLone D, Knepper P . The cause of Chiari II malformation: a unified theory. Pediatr Neurosci. 1989; 15(1):1-12. DOI: 10.1159/000120432. View

11.

Sieben R, HAMIDA M, Shulman K . Multiple cranial nerve deficits associated with the Arnold-Chiari malformation. Neurology. 1971; 21(7):673-81. DOI: 10.1212/wnl.21.7.673. View

12.

BARNET A, Weiss I, Shaer C . Evoked potentials in infant brainstem syndrome associated with Arnold-Chiari malformation. Dev Med Child Neurol. 1993; 35(1):42-8. DOI: 10.1111/j.1469-8749.1993.tb11550.x. View

13.

Buyse G, Caekebeke J, Demaerel P, Plets C . Primary brain stem tethering: a rare cause of geniculate neuralgia. J Laryngol Otol. 2000; 113(10):945-7. DOI: 10.1017/s0022215100145670. View

14.

Chia L . Late blink reflex changes in lesions of thalamus and internal capsule. Neurology. 1997; 49(3):874-6. DOI: 10.1212/wnl.49.3.874. View

15.

Nishimura T, Mori K . Blink reflex in meningomyelocele, with special reference to its usefulness in the evaluation of brainstem dysfunction. Childs Nerv Syst. 1996; 12(1):2-12. DOI: 10.1007/BF00573848. View

16.

Hopf H, Thomke F, Gutmann L . Midbrain vs. pontine medial longitudinal fasciculus lesions: the utilization of masseter and blink reflexes. Muscle Nerve. 1991; 14(4):326-30. DOI: 10.1002/mus.880140406. View

17.

Koehler J, Schwarz M, Urban P, VOTH D, Holker C, Hopf H . Masseter reflex and blink reflex abnormalities in Chiari II malformation. Muscle Nerve. 2001; 24(3):425-7. DOI: 10.1002/1097-4598(200103)24:3<425::aid-mus1017>3.0.co;2-k. View

18.

Cusick J, Myklebust J, Zyvoloski M, Sances Jr A, Houterman C, Larson S . Effects of vertebral column distraction in the monkey. J Neurosurg. 1982; 57(5):651-9. DOI: 10.3171/jns.1982.57.5.0651. View

19.

Hoffman H, HENDRICK E, Humphreys R . Manifestations and management of Arnold-Chiari malformation in patients with myelomeningocele. Childs Brain. 1975; 1(4):255-9. DOI: 10.1159/000119575. View

20.

Cochrane D, Adderley R, White C, Norman M, Steinbok P . Apnea in patients with myelomeningocele. Pediatr Neurosurg. 1990; 16(4-5):232-9. DOI: 10.1159/000120533. View