Pollak L, Kushnir M, Stryjer R
Department of Neurology, The Assaf Harofeh Medical Center, Zerifin, Israel; Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Neurophysiol Clin. 2006 Jul-Aug;36(4):227-33. doi: 10.1016/j.neucli.2006.08.014. Epub 2006 Sep 18.
Vestibular evoked myogenic potentials (VEMPs) provide assessment of vestibular function. They consist in picking up compound muscle action potentials in the sternocleidomastoid (SCM) muscles in response to auditory stimulation of the vestibulum. VEMP testing has found application mainly in peripheral vestibular disorders, whereas reports about VEMPs in central vestibular lesions are rather scarce.
Based on the physiological connections between the cerebellum and the vestibular nuclei, we investigated the influence on VEMPs of cerebellar and lower-brainstem strokes. We examined whether or not this method may be suitable as a clinical tool for the evaluation of the extent of cerebellar strokes.
Nineteen patients with cerebellar ischemic stroke and 15 patients with lower-brainstem ischemic stroke (11 in the pons, four in the medulla) were included. The latencies and amplitudes of P13 and N23 in both groups of patients were compared with those obtained in a control group of 53 normal individuals.
VEMP responses were obtained in all patients and controls. At the group level, mean peak latencies and amplitudes, and the number of subjects with significantly deviant values did not differ between patients and controls. There were no latency or amplitude differences ipsilaterally or contralaterally to the lesion. At the individual level, there was no correlation between laterality of lesion and that of P13 or N23 abnormalities in patients with cerebellar strokes; however, there were two patients (one pontine, one medullar stroke) who presented P13 and N23 latency abnormalities ipsilaterally to the lesion.
Cerebellar strokes do not influence VEMPs. Moreover, despite previous reports, we were unable to find at a group level any statistically significant VEMP changes in patients with lower-brainstem strokes as compared with controls. Therefore, VEMPs do not appear a suitable tool for assessment of brainstem integrity in patients with posterior fossa strokes. However, they could constitute a sensitive method for documentation of involvement of the central vestibular pathways in patients with brainstem stroke.
前庭诱发肌源性电位（VEMPs）用于评估前庭功能。它是通过对前庭进行听觉刺激，采集胸锁乳突肌（SCM）中的复合肌肉动作电位。VEMP测试主要应用于外周前庭疾病，而关于中枢前庭病变中VEMPs的报道相对较少。
基于小脑与前庭核之间的生理联系，我们研究了小脑和脑干下部中风对VEMPs的影响。我们考察了该方法是否适合作为评估小脑中风范围的临床工具。
纳入19例小脑缺血性中风患者和15例脑干下部缺血性中风患者（脑桥11例，延髓4例）。将两组患者P13和N23的潜伏期和波幅与53名正常个体组成的对照组进行比较。
所有患者和对照组均获得VEMP反应。在组水平上，患者和对照组的平均峰潜伏期、波幅以及值明显异常的受试者数量没有差异。病变同侧或对侧的潜伏期或波幅均无差异。在个体水平上，小脑中风患者病变的侧别与P13或N23异常的侧别之间没有相关性；然而，有两名患者（1例脑桥中风，1例延髓中风）在病变同侧出现P13和N23潜伏期异常。
小脑中风不影响VEMPs。此外，尽管有先前的报道，但我们在组水平上未发现脑干下部中风患者与对照组相比有任何具有统计学意义的VEMP变化。因此，VEMPs似乎不是评估后颅窝中风患者脑干完整性的合适工具。然而，它们可能是记录脑干中风患者中枢前庭通路受累情况的一种敏感方法。
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