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Posterior auricular muscle response: observations in brainstem lesions [Turk J Neurol]
Turk J Neurol. Ahead of Print: TJN-57255

Posterior auricular muscle response: observations in brainstem lesions

Yeşim Gülen Abanoz1, Yasin Abanoz1, Yasemin Akıncı1, Ayşegül Gündüz1, Eser Buluş2, Melih Tütüncü1, Sabahattin Saip1, Meral Erdemir Kızıltan1
1Istanbul University Cerrahpaşa Faculty of Medicine, Department of Neurology, Istanbul, Turkey
2Medical Park Gaziosmanpasa Hospital, Neurology, Istanbul, Turkey

Objective: Posterior auricular muscle response (PAMR) is a myogenic potential recorded over posterior auricular muscle (PAM) after auditory stimulation. Its circuit is formed by cochlear and facial nerves with the generator in the brainstem. Here, we investigated whether addition of posterior auricular muscle response (PAMR) examination would add an additional use in determining or localizing isolated brainstem lesions since the importance of blink reflex (BR) in determining or localizing brainstem lesions is known. Our hypothesis was that examination of both reflexes would increase the clinical utility.
Materials and Methods: We included 34 patients with isolated brainstem lesions (multiple sclerosis, ischemic stroke and cerebellopontine angle schwannoma) and 41 healthy subjects. PAMRs were recorded over posterior auricular muscle (PAM) after auditory stimulation. BR was elicited by the electrical stimulation of the supraorbital nerve.
Results: PAMR was present in 82.9% of healthy subjects whereas presence was quite low in the patient group (38.2%, p=0.001). Mean latency of PAMR was delayed in patients compared to healthy subjects (p=0.001). BR was obtained in all healthy subjects whereas prolonged latencies or absence of BR was observed in the patient group. There were no differences according to the different etiologies or localization.
Conclusion: Although presence of PAMR is quite high, its absence does not always indicate a pathology. But prolonged latencies almost always suggest an involvement of PAMR pathway. Likewise, absent PAMR with an abnormal BR provides information for the involvement of brainstem facial nucleus or proximal part of the facial nerve.

Keywords: posterior auricular muscle response, blink reflex, brainstem, multiple sclerosis, stroke




Corresponding Author: Yasemin Akıncı, Türkiye


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