Orbicularis oculi reflex abnormalities in patients with multiple sclerosis: a clinical, EMG, and MRI investigation.

Examination of the orbicularis oculi reflex (OOR) has been used for many years in the diagnostic algorithm of multiple sclerosis (MS) in a few aspects: to define existence and specific location of the lesions and to follow-up dynamic changes in pontine and supranuclear structures of the CNS. Correlation between MRI and electrophysiological data from OOR has not been widely studied in the patients with MS. The aim of the present study is to assess the changes of OOR in patients with MS and their relation to clinical and MRI brainstem findings. Forty-six patients were examined by complex EMG, MRI, and clinical protocol, aged from 21 to 55. Two groups were formed: first group of 40 patients with relapsing remitting MS (RRMS) and second group of six patients with secondary progressive (SPMS). About one third of the patients had neither clinical nor OOR or MRI brainstem abnormal changes. In 22.5% of the cases a clinical, EMG and MRI correlation, showing brainstem lesions, was found We observed different changes in OOR responses in about three fourths of all patients, respectively in 75% of patients with RRMS and in 83.3% of those with SPMS. OOR examination gives us evidence of additional brain lesions in 15% of our patients, whose MRI and clinical findings were unremarkable. Prolonged latency of the first and second component of OOR, additionally with asymmetry or lack of response, was more commonly related to the clinical manifestation.

Functional methods for evaluation the occurrence of delayed ischemic deficit in patients with subarachnoid hemorrhage.

Detection of early circulatory and electrophysiologic changes due to vasospasm (VS) after subarachnoid hemorrhage (SAH) is a necessity for in-time and adequate therapeutic management. The aim of the present case report is to describe and demonstrate the results of transcranial Doppler (TCD) monitoring and brainstem auditory evoked potentials (BAEPs) examination, which indicate the development of combined circulatory insufficiency in two vascular systems. On the 14th day after SAH, TCD showed accelerated velocities in the territory of middle cerebral artery (MCA) and basilar artery (BA). BAEPs, after ipsilateral stimulation, performed on the same day verified changes of potentials on the left side with abnormal I/V amplitude ratio. These results were suggestive of brainstem dysfunction. The CT examination of the next day revealed infarction in the posterior parietal borderline zone of the left hemisphere. The patient had clinical signs of sensory aphasia, which resolved completely after one-week treatment with nimodipine.