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Some observations on the blink reflex in posttraumatic coma.

E Rumpl, F Gerstenbrand, J M Hackl

    Electroencephalography and Clinical Neurophysiology
    |October 1, 1982
    PubMed
    Summary
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    Blink reflex studies in comatose patients show that mechanical stimulation is effective for assessing brain stem function. Early recovery of blink reflexes, particularly R2, indicates good prognosis after head injury.

    Area of Science:

    • Neuroscience
    • Neurology
    • Clinical Neurophysiology

    Background:

    • Comatose patients with brain stem impairment require accurate prognostic indicators.
    • Head injuries can cause primary brain stem lesions or secondary lesions due to mass effect.
    • Assessing brain stem function is crucial for predicting outcomes in traumatic brain injury.

    Purpose of the Study:

    • To investigate the utility of blink reflex studies in evaluating brain stem function in comatose patients.
    • To correlate blink reflex responses with the type and severity of brain stem injury and patient outcomes.
    • To compare the effectiveness of mechanical versus electrical stimulation for eliciting blink reflexes.

    Main Methods:

    • Blink reflex studies were performed on 51 comatose patients with suspected brain stem impairment.

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  • Patients were categorized by coma duration (acute vs. prolonged), brain stem lesion type (primary vs. secondary), and EEG state (sleep vs. alert).
  • Mechanical and electrical stimulation were used to record blink reflexes, focusing on late responses (R1 and R2).

    • Main Results:

    • Mechanical stimulation was more effective than electrical stimulation in eliciting late blink reflex responses.
    • Late responses were absent in acute coma during 'sleep' states but present in 'alert' states, particularly with mechanical stimulation.
    • Early recovery of blink reflexes, especially R2, correlated with good outcomes in both primary and secondary brain stem injury.
    • Consistent absence of R2 and R1 in prolonged coma indicated a poor prognosis.

    Conclusions:

    • Blink reflex testing, especially with mechanical stimulation, is a valuable tool for assessing brain stem function in comatose patients.
    • The presence and early recovery of blink reflex components, particularly R2, are significant predictors of favorable outcomes after head injury.
    • Prognostic significance of blink reflexes is highest in the acute stage of coma and diminishes in prolonged coma.