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Transient Middle Cerebral Artery Occlusion Model of Stroke

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Medullary infarcts may cause ipsilateral masseter reflex abnormalities.

Frank Thömke¹, Jürgen J Marx, Giorgio Cruccu

¹Department of Neurology, University of Mainz, Langenbeckstr 1, D-55101, Mainz, Germany. thoemke@neurologie.klinik.uni-mainz.de

|July 28, 2007

Summary

Brainstem infarcts affecting the fifth nerve spinal nucleus (5SpN) can cause abnormal masseter reflexes (MassR) in humans. This finding may alter the diagnostic use of MassR in patients with medullary lesions.

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Area of Science:

Neurology
Neuroscience
Clinical Medicine

Background:

Suprasegmental control of the masseter reflex (MassR) is known in animals via the fifth nerve spinal nucleus (5SpN).
Human data regarding this suprasegmental influence on MassR is limited.
The diagnostic utility of MassR in localizing brainstem lesions is under investigation.

Purpose of the Study:

To investigate the influence of brainstem infarcts on the masseter reflex (MassR) in humans.
To determine if lesions involving the fifth nerve spinal nucleus (5SpN) correlate with MassR abnormalities.
To assess the impact of medullary lesions on the topodiagnostic value of MassR.

Main Methods:

Prospective recruitment of 268 patients with acute brainstem infarction signs.
Identification of 38 patients with MRI-documented unilateral infarcts caudal to the trigeminal nerve nuclei.
Performance of biplanar T2- and echo planar diffusion-weighted MRI and masseter reflex testing.

Main Results:

Five patients (13%) exhibited ipsilateral MassR abnormalities.
All patients with MassR abnormalities had infarcts involving the region of the fifth nerve spinal nucleus (5SpN).
Infarcts were located caudal to the fifth nerve motor and main sensory nuclei.

Conclusions:

Medullary infarcts involving the fifth nerve spinal nucleus (5SpN) can lead to ipsilateral masseter reflex (MassR) abnormalities in humans.
This suggests an interrupted excitatory projection from the 5SpN to masseter motoneurons.
MassR abnormalities in the presence of medullary lesions may limit its topodiagnostic value.