[Electrophysiologic brain stem diagnosis. Acoustic evoked brain stem potentials--pattern recognition and significance for the function of the brain stem].
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Biomedical subjects
Publications and source records attributed to H Röder.
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The results of the Orbicularis oculi reflex (OOR) and the anditory evoked brain stem potential (a. e. BSP) supplement each other in the furnished information in lesions of the central and lower brain stem. The a. e. BSP permits quite a reliable localisation in the brain stem and in the cerebellopontile angle. the OOR moreover helps to discover disturbances in the N. facialis and the N. trigeminus. In intracanalicularly situated acousticus neurinomas lacking a. e. BSP the pathologically changed reflex response of the OOR indicates the process in the internal auditory canal.
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Auditory evoked brain stem potentials (seven waves within the first 10 milliseconds after the stimulus) obtained from the intercalated nuclei within the auditory pathway by averaging are suitable for a functional diagnosis of the brain stem. Disorders affecting the auditory pathway (direct or indirect tumour pressure or infiltrates, demyelinisation processes, traumatic brain stem injuries, ischemia) from the acoustic nerve through the cochlear nuclei, the superior olivary nuclei, the nuclei of the lateral lemnisci, the inferior collicular nuclei, to the medial geniculate bodies can be identified and used for the topical diagnosis.
Four cases of brain-stem tumor were described, in which myokymias were electromyographically derived from the region of several cerebral nerves. An attempt is made to interpret the effects of twitching by reference to the electromyogram. Myokymias are a positive indication of organic brain stem damage. The use subtle techniques of electromyographic examination shows that this muscular hyperkinesis is not so infrequent a symptom as is generally believed.
Examinations of the eyegrounds were made on thirty subjects after conduction anesthesia with xylocitin of the inferior alveolar nerve as well as on nine subjects after sodium chloride injections in order to determine the effect of mandibular conduction anesthesia on retinal vessels. Retinal vascular widths were measured and arteriovenous indices determined. The subjects were divided into groups according to preexisting general diseases, age, sex, and smoking habits. Retinal vascular changes were determined in dependence on age and smoking habits after injections made into the mandibular foramen, and the manner of origin and the results are discussed with particular reference to data reported in the literature.
The results of studies performed by the authors show that time measurements of proprioceptive muscular reflexes (triceps surae and tibialis posterior reflexes) may be considered a valuable addition to methods of topical diagnosis of radicular disturbances in the lumbosacral region. The reflexes were tested in twenty normal subjects. There were found an intraindividual constancy of the respective reflex time with a maximum deviation of 2 ms as well as a lateral variability up to 1.3 ms. Radicular compressions resulted in an increase in reflex time by 2 to 66 ms or failure of the reflex potential to be recorded. The pathological cases were compared with clinical and neurological studies, positive myelographies using radiopaque substances, and results of surgical operations. Compared with the results of surgical operations, changes in reflex time indicated damage to the reflex arc in ninety percent of the cases.
A case is described where relapsing alternating cerebral nerve pareses were frequently observed in the course of twelve years. The neurogenic character of the pareses could be demonstrated by electromyography. The extremities examined also showed signs of subclinical changes of the peripheral nervous system. The results of examinations suggest that the patient has an idiopathic form of polyneuropathy, the clinical manifestation of which is restricted to the cerebral nervous system. The literature on relapsing cerebral nerve pareses is discussed briefly.
Clinical and neurological as well as electromyographic examinations were made on twenty-five subjects working in agriculture and handling plant protection products. Measurements of the rate of nerve conduction were made on the peroneal and median nerves. The average rate of conduction of the peroneal nerve was found to be reduced in persons who had been exposed o plant protectives for more than three years. Electroneurography appears to be useful method of recognizing polyneuropathic symptoms of chronic and toxic affections caused by insecticides.
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