Brainstem reflex circuits revisited

被引:128
作者
Cruccu, G
Iannetti, GD
Marx, JJ
Thoemke, F
Truini, A
Fitzek, S
Galeotti, F
Urban, PP
Romaniello, A
Stoeter, P
Manfredi, M
Hopf, HC
机构
[1] Univ Roma La Sapienza, Dept Neurol Sci, I-00185 Rome, Italy
[2] Univ Oxford, Dept Human Anat & Genet, Oxford, England
[3] Univ Oxford, FMRIB Ctr, Oxford, England
[4] Johannes Gutenberg Univ Mainz, Dept Neurol, D-6500 Mainz, Germany
[5] Johannes Gutenberg Univ Mainz, Dept Neuroradiol, D-6500 Mainz, Germany
[6] Univ Jena, Dept Neurol, D-6900 Jena, Germany
关键词
brainstem infarction; brainstem reflexes; MRI; anatomical-functional correlation;
D O I
10.1093/brain/awh366
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Our current understanding of brainstem reflex physiology comes chiefly from the classic anatomical-functional correlation studies that traced the central circuits underlying brainstem reflexes and establishing reflex abnormalities as markers for specific areas of lesion. These studies nevertheless had the disadvantage of deriving from post-mortem findings in only a few patients. We developed a voxel-based model of the human brainstem designed to import and normalize MRIs, select groups of patients with or without a given dysfunction, compare their MRIs statistically, and construct three-plane maps showing the statistical probability of lesion. Using this method, we studied 180 patients with focal brainstem infarction. All subjects underwent a dedicated MRI study of the brainstem and the whole series of brainstem tests currently used in clinical neurophysiology: early (R1) and late (R2) blink reflex, early (SP1) and late (SP2) masseter inhibitory reflex, and the jaw jerk to chin tapping. Significance levels were highest for R1, SP1 and R2 afferent abnormalities. Patients with abnormalities in all three reflexes had lesions involving the primary sensory neurons in the ventral pons, before the afferents directed to the respective reflex circuits diverge. Patients with an isolated abnormality of R1 and SP1 responses had lesions that involved the ipsilateral dorsal pons, near the fourth ventricle floor, and lay close to each other. The area with the highest probabilities of lesion for the R2-afferent abnormality was in the ipsilateral dorsal-lateral medulla at the inferior olive level. SP2 abnormalities reached a low level of significance, in the same region as R2. Only few patients had a crossed-type abnormality of SP1, SP2 or R2; that of SP1 reached significance in the median pontine tegmentum rostral to the main trigeminal nucleus. Although abnormal in 38 patients, the jaw jerk appeared to have no cluster location. Because our voxel-based model quantitatively compares lesions in patients with or without a given reflex abnormality, it minimizes the risk that the significant areas depict vascular territories rather than common spots within the territory housing the reflex circuit. By analysing statistical data for a large cohort of patients, it also identifies the most frequent lesion location for each response. The finding of multireflex abnormalities reflects damage of the primary afferent neurons; hence it provides no evidence of an intra-axial lesion. The jaw jerk, perhaps the brainstem reflex most widely used in clinical neurophysiology, had no apparent topodiagnostic value, probably because it depends strongly on peripheral variables, including dental occlusion.
引用
收藏
页码:386 / 394
页数:9
相关论文
共 38 条
[1]  
[Anonymous], 1995, Atlas of the human brainstem
[2]   The late blink reflex response abnormality due to lesion of the lateral tegmental field [J].
Aramideh, M ;
deVisser, BWO ;
Koelman, JHTM ;
Majoie, CBL ;
Holstege, G .
BRAIN, 1997, 120 :1685-1692
[3]   Three-dimensional mapping of brainstem functional lesions [J].
Capozza, M ;
Iannetti, GD ;
Mostarda, M ;
Cruccu, G ;
Accornero, N .
MEDICAL & BIOLOGICAL ENGINEERING & COMPUTING, 2000, 38 (06) :639-644
[4]   Excitability of the central masticatory pathways in patients with painful temporomandibular disorders [J].
Cruccu, G ;
Frisardi, G ;
Pauletti, G ;
Romaniello, A ;
Manfredi, M .
PAIN, 1997, 73 (03) :447-454
[5]   The clinical use of brainstem reflexes and hand-muscle reflexes [J].
Cruccu, G ;
Deuschl, G .
CLINICAL NEUROPHYSIOLOGY, 2000, 111 (03) :371-387
[6]   NOCICEPTIVE QUALITY OF THE ORBICULARIS OCULI REFLEXES AS EVALUATED BY DISTINCT OPIATE-INDUCED AND BENZODIAZEPINE-INDUCED CHANGES IN MAN [J].
CRUCCU, G ;
FERRACUTI, S ;
LEARDI, MG ;
FABBRI, A ;
MANFREDI, M .
BRAIN RESEARCH, 1991, 556 (02) :209-217
[7]   Excitability of the human trigeminal motoneuronal pool and interactions with other brainstem reflex pathways [J].
Cruccu, G ;
Truini, A ;
Priori, A .
JOURNAL OF PHYSIOLOGY-LONDON, 2001, 531 (02) :559-571
[8]  
DARIANSMITH I, 1973, HDB SENSORY PHYSIOLO, V2, P271, DOI [10.1007/978-3-642-65438-1_10., DOI 10.1007/978-3-642-65438-1_10]
[9]  
DEUSCHL G, 1999, ELECTROENCEPHALOGR S, V52
[10]   EFFECTS OF BRAIN-STEM LESIONS ON THE MASSETER INHIBITORY REFLEX - FUNCTIONAL MECHANISMS OF REFLEX PATHWAYS [J].
DEVISSER, BWO ;
CRUCCU, G ;
MANFREDI, M ;
KOELMAN, JHTM .
BRAIN, 1990, 113 :781-792