Blink reflex in meningomyelocele, with special reference to its usefulness in the evaluation of brainstem dysfunction

The electrically elicited blink reflex (BR) was studied in 30 patients with meningomyelocele (MMC), including 21 with Chiari type II malformation. The relationship between the BR and brainstem auditory evoked potentials (BAEPs) is discussed with regard to its usefulness in the evaluation of MMC's brainstem dysfunction. The following results were obtained: (1) The R2 component was abnormal in 90% of these patients. The BR disclosed subclinical lesions in the medulla oblongata which were not detected by BAEPs alone. (2) In all patients in whom the BAEPs suggested the presence of stretched cochlear nerves, the BR indicated the existence of some dysfunction of the medulla oblongata. (3) No close relationship was found between the dysfunction detected by the BR and the degree of hindbrain anomaly on the neuroimaging. (4) Combining results from assessment of the measurement of the BR and BAEPs permits evaluation of the function of the fifth, seventh, and eighth cranial nerves, as well as the brainstem including the medulla oblongata, which is more comprehensive than evaluation by neuroimaging alone.