Medial vestibulospinal tract lesions impair sacculo-collic reflexes |
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Authors: | Seonhye Kim Hak-Seung Lee Ji Soo Kim |
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Institution: | (1) Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang, Seongnam, Gyeonggi, 463-707, South Korea;(2) Department of Neurology, Wonkwang University School of Medicine, Iksan, South Korea; |
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Abstract: | The medial vestibulospinal tract (VST) is known to mediate the vestibular-evoked myogenic potential (VEMP) in the contracting
sternocleidomastoid muscle (SCM). To determine whether disruption of the medial VST in the medulla impairs formation of VEMP,
we measured VEMP in 14 patients with medial medullary infarction (MMI). VEMP was induced by a short tone burst and was recorded
in contracting SCM while patients turned their heads forcefully to the contralateral side against resistance. Normative data
were obtained from 47 healthy volunteers. Seven patients (50%) had abnormal VEMP in the side of the MMI lesion, absent in
two, decreased in four, and delayed in two. One patient showed both decreased and delayed response. Of the seven patients
with abnormal VEMP, five had the lesions that extended to the dorsal tegmentum while five of the seven patients with normal
VEMP showed restricted anteromedial lesions mainly involving the pyramids. Spontaneous nystagmus (4/7, 57%), gaze-evoked nystagmus
(6/7, 86%), and ocular tilt reaction/tilt of the subjective visual vertical (4/7, 57%) were frequently observed in the patients
with abnormal VEMP. The abnormal VEMP in patients with infarctions involving the medullary tegmentum supports that VEMP is
mediated by the medial VST descending within the medial longitudinal fasciculus. |
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