Brain, Vol 120, Issue 9 1685-1692, Copyright © 1997 by Oxford University Press
M Aramideh, BW Ongerboer de Visser, JH Koelman, CB Majoie and G Holstege
We report on a blink reflex abnormality observed in two patients, which
provides additional information on the central pathways mediating this
reflex. Autopsy was performed in one patient and MRI in the other. In the
first patient there was a small lesion at the dorsal middle third of the
lateral tegmental field and in the second patient at the level of the
dorsal lower third of the medulla oblongata. In both patients the common
finding was the absence of the late response (R2) ipsilateral to the side
of the lesion, while the R2 response on the unaffected side was normal
regardless of the side of the supraorbital nerve stimulation. The R1
responses were normal. This type of blink reflex abnormality has not been
reported before and is referred to by us as 'tegmental type' of R2
abnormality. The results led to the conclusions that: (i) the crossed and
uncrossed ascending trigeminofacial connections are mediated through the
lateral tegmental field; (ii) the uncrossed trigeminofacial connection
originates at the level of at least the lower medulla oblongata; (iii) the
contralateral R2 response is established by way of an ascending pathway,
which crosses the midline at the level of at least the lower third of the
medulla oblongata.
ARTICLES
The late blink reflex response abnormality due to lesion of the lateral tegmental field
Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands.
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