ID 252 – Auditory startle reflex (ASR) in ischemic and hemorrhagic stroke

Objective To evaluate the influence of cortical and subcortical vascular lesions on ASR. Methods We studied in 16 patients (9 middle cerebral artery (MCA) lesions and 7 basal ganglia hematoma (BGH)): ASR, MEP, cortical silent period, H reflex and Fugl-Meyer and Ashworth scale. Six were evaluated in the acute phase, 6 in subacute and chronic phases and 4 in both. Results Four of 5 BGH patients evaluated in the acute phase had an absent ASR and one responded only on the clinically spared side. On the contrary, four of 5 MCA patients evaluated in the acute phase presented an increased biceps response on the clinically affected side (CAS). In subacute and chronic phases 3 of 5 MCA and 4 of 5 BGH patients developed enhanced biceps responses on the CAS. Conclusions Enhanced ASR in vascular lesions can be due to a loss of the inhibitory hemispheric or basal ganglia drive on ASR generators. The absence of ASR in the acute phase of BGH could suggest a transient hypofunction of brainstem structures. Key message Ischemic stroke can be associated with an increased ASR on the CAS and BGH with an absent ASR in the acute phase, which is enhanced in subacute and chronic phases.