Trigeminal small-fibre dysfunction in patients with diabetes mellitus: a study with laser evoked potentials and corneal reflex
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Trigeminal Nerve
Abnormality
Evoked potential
Objective:To explore the value of blink reflex(BR)and brainstem auditory evoked potential(BAEP)in the diagnosis of acoustic neuroma(AN).Methods:Forty normal persons and 78 AN patients were examined with BR and BAEP respectively.Results:In 78 patients with AN the abnormality rate of BR was 97% and the abnormality rate of BAEP was 99% respectively,in which the abnormality rate of BR was 84% and the abnormality rate of BAEP was 95% respectively in 19 cases with small neuromas;in 59 cases with medum and large neuromas,BAEP of 44 cases disappeared.Conclusions:Subclinical lesions in brainstem,V and Ⅶ cranial nerves ware demonstrated by BR.The combined abnormality rate of BR and BAEP contvibates to the early diagnosis of AN.
Abnormality
Subclinical infection
Acoustic neuroma
Acoustic reflex
Neuroma
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We investigated the frequency of subclinical trigeminal and facial nerve involvement in 40 patients with diabetes mellitus and without clinical signs of cranial nerve lesions. 60% of the patients had distal symmetric sensory polyneuropathy which was confirmed by nerve conduction studies. Trigeminal and facial nerve functions were evaluated electrophysiologically using the blink-reflex R1 component (BlinkR-R1), masseter reflex (MassR), the first exteroceptive suppression of the masseter muscle (Mass-ES1), and distal motor latency of the facial nerve (DML VII). Latencies were significantly prolonged for the BlinkR-R1 (p < 0.0001), the Mass-ES1 (p < 0.05), and DML VII (p < 0.005) in diabetics compared with controls. No significant difference was found for the MassR. Prolonged latencies (> mean + 2.5 SD of age-matched controls) were demonstrated for the Mass-ES1 in 12.5%, BlinkR-R1 in 10%, DML VII in 6.2%, and MassR in 5% in individual of patients. Our findings indicate that trigeminal and facial nerve involvement is not infrequent in diabetics, although it is significantly less frequent than limb nerve involvement.
Trigeminal Nerve
Subclinical infection
Motor nerve
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Eighteen patients with intracranial trigeminal nerve lesions were investigated electrodiagnostically. The trigeminal motor root function was studied on the basis of the jaw reflex and masseter myograms and was disturbed in all cases. The jaw reflexes were abnormal in 16 and the masseter myograms in eight cases. An impressive trigeminal sensory root function was obtained from blink reflex, which was abnormal in 12 cases. The results show the diagnostic value of bilateral recording of the jaw reflex in such patients.
Jaw jerk reflex
Trigeminal Nerve
Oculocardiac reflex
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Although a certain level of expertise is necessary, electrophysiologic study of cranial reflexes is not technically demanding, time-consuming, or associated with substantial patient discomfort. The information obtained may document objective abnormality and assist with localization. The blink reflexes are useful for studying the function of the trigeminal and facial nerves and their central connections in the brain stem. When NCS in the limbs suggest a demyelinating peripheral neuropathy, the blink reflex can provide information about involvement of proximal nerve segments. Patterns of involvement of the facial and trigeminal nerves are often helpful in suggesting the type of neuropathy under investigation. The jaw jerk is useful in assessing the mandibular division of the trigeminal nerve, and it can aid in evaluating patients with suspected sensory ganglionopathies. The MIR is sometimes helpful in evaluating patients with demyelinating neuropathies and in assessing central inhibition. The great auricular sensory NCS is a useful method to assess proximal somatic sensory function in the upper cervical dermatomes. The CHEPS technology provides a method to study somatic small fiber sensory pathways from the trigeminal dermatomes to the sensory cortex. Although not discussed in this chapter, needle electrode examination of muscles innervated by the trigeminal and facial cranial nerves are usually performed in combination with cranial nerve reflex studies.
Trigeminal Nerve
Cranial nerves
Jaw jerk reflex
Sensory nerve
Triceps reflex
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Fourteen patients with unilateral trigeminal neuropathy of unknown origin were examined 5 to 30 years after onset of the illness. In one patient, sensory loss in the area of the mental nerve was probably due to the pressure of the denture. In another three patients there were signs suggestive of multiple sclerosis. In the remaining ten patients there were no manifestation of any additive progressive disease or polyneuropathy. Unilateral trigeminal neuropathy is a benign disorder. The symptoms can persist, regress or even completely disappear. The significant delay in the reflex response of the blink reflex many years after onset of the disease probably signifies a very extensive involvement in the trigeminal nerve. In this disorder there seems to be no relationship to trigeminal neuralgia. In the examined cases viral etiology of the unilateral trigeminal neuropathy could be postulated. This disorder can extent to all three branches of trigeminal or even facial nerve.
Trigeminal Nerve
Etiology
Jaw jerk reflex
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The electrically elicited blink reflex allows quantitative analysis of the corneal reflex which traverses the trigeminal and facial nerves and the brainstem. Two patients presenting with symptomatic unilateral trigeminal lesions are described, in whom the blink reflexes showed conduction block and slowing at predictable sites in the central pathways, and magnetic resonance imaging confirmed precisely the clinical and electrophysiological localisation.
Trigeminal Nerve
Jaw jerk reflex
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The main aim of this study is to evaluate the role of blink reflex for early diagnosis of cranial neuropathy in diabetic patients with or without polneuropathy. Ninety-five diabetic patients were included in the present study for the evaluation of blink reflex. The diabetic patients were divided into two groups according to having diabetic neuropathy or not. Both R1, R2i and R2c latencies in all diabetic patients with or without polyneuropathy were prolonged relative to controls and the differences were statistically significant (p < .001). R1 latencies in diabetic patients with polyneuropathy were prolonged relative to diabetic patients without polyneuropathy and the differences were statistically significant (p < .001). These findings presumably reflect that facial nerve is severly involved in diabetic polyneuropathy. Finally blink reflex is of value in detection of clinically silent intraaxial brainstem functional abnormalities or extraaxial lesions in diabetic patients before peripheral neuropathy.
Diabetic Neuropathy
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Using a new technique to record the latency of the corneal reflex, we established normal values in 32 normal subjects between 10 and 80 years of age, divided into three age groups. In 15 patients with unilateral trigeminal nerve lesions, comparison of the responses on both sides permitted differentiation of afferent and efferent lesions.
Trigeminal Nerve
Oculocardiac reflex
Supraorbital nerve
Pupillary reflex
Triceps reflex
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Abstract Objective To reassess reference values for the components of the electrically induced blink reflex, document reference values for facial motor nerve conduction velocity, and demonstrate usefulness of the blink reflex as a diagnostic tool in peripheral facial and trigeminal nerve dysfunction in horses. Animals 10 healthy adult horses (8 males, 2 females) without neurologic abnormalities. Procedure Blink reflex tests were performed by electrical stimulation of the supraorbital nerve and facial (auriculopalpebral) nerve. Reflex and direct muscle-evoked potentials of the orbicularis oculi muscles were recorded from concentric needle electrodes inserted bilaterally in these muscles. Supraorbital and auriculopalpebral nerve blocks were performed by lidocaine hydrochloride injections. Results Supraorbital nerve stimulation elicited 2 or 3 ipsilateral and 1 contralateral reflex muscle potential in the orbicularis oculi muscles. Auriculopalpebral nerve stimulation elicited a direct and a reflex potential in the ipsilateral orbicularis oculi muscle. After left supraorbital nerve block, no responses could be elicited ipsilaterally or contralaterally upon stimulation of the blocked nerve, but bilateral responses were obtained upon stimulation of the right supraorbital nerve. After right auriculopalpebral nerve block, no responses were recorded from the right orbicularis oculi muscle upon stimulation of left or right supraorbital nerves. Conclusions and Clinical Relevance Reference values for the components of the blink reflex and facial motor nerve conduction velocity will allow application of these tests to assist in the diagnosis of equine neurologic disorders involving the trigeminal and facial nerves, the brainstem, and the cranial end of the cervical segment of the spinal cord. This study reveals the usefulness of the blink reflex test in the diagnosis of peripheral trigeminal and facial nerve dysfunction in horses. ( Am J Vet Res 1999;60:1287–1291)
Trigeminal Nerve
Oculocardiac reflex
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Trigeminal Nerve
Spinal trigeminal nucleus
Supraorbital nerve
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