[Chronological changes in the blink reflex and MRI in a patient with lateral medullary infarction]

Recently, the brainstem pathways of bilateral late reflexes (R2) of electrically elicited blink reflex have been well established. An afferent delay or block of the late reflexes is closely related to a lesion of the lateral medullary portion. The chronological alteration of blink reflex (BR) was studied to compare with radiological abnormalities on MRI in a patient with lateral medullary infarction on the right side. A diagnosis of Wallenberg syndrome was made clinically and location of the lesion was identified in detail by MRI. The infarcted region which was well demonstrated as an increased intensity area on SE images obtained 52 days after the onset of symptoms was much smaller than that on SE as well as on IR image 21 days after the onset of symptoms. Therefore, it was concluded that more than half of the increased intensity area on the SE images obtained 21 days after the onset of symptoms recovered from the condition of being extremely damaged by ischemia on the right lateral medullary portion in this patient. On the other hand, in the initial BR 26 days after the onset of symptoms, the late reflexes (R2) were consistently absent bilaterally when the affected side (right) was stimulated and normal when the normal side (left) was stimulated. This type of BR abnormality is compatible with an afferent block of late reflexes (R2). The early reflex (R1) was normal on either side. Whereas in the second BR at 55 days after the onset of symptoms, the late reflexes turned to be normal in latency when the right side was stimulated.(ABSTRACT TRUNCATED AT 250 WORDS)