Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-25T08:21:57.477Z Has data issue: false hasContentIssue false
  • English
  • Français

TMS Neuro-Cardiovascular Coupling in Vascular Compression Cranial Neuropathy

Published online by Cambridge University Press:  02 December 2014

Adam Kirton ,
Carolyn Gunraj  and
Robert Chen
Adam Kirton*
Affiliation:
Division of Neurology, Alberta Children's Hospital, University of Calgary, Calgary, Alberta
Carolyn Gunraj
Affiliation:
Division of Neurology, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada
Robert Chen
Affiliation:
Division of Neurology, Toronto Western Research Institute, University of Toronto, Toronto, Ontario, Canada
*
Division of Neurology, Department of Pediatrics, Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, Alberta, T6B 3A8, Canada.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Neurovascular compression (NVC) may cause cranial mononeuropathy but lacks a definitive diagnostic investigation. We hypothesized that the arterial pressure wave (APW) would interact at the neurovascular interface in NVC to inhibit transmission of transcranial magnetic stimulation (TMS) stimuli to affected muscles.

Methods:

We report a novel neurophysiological method coupling cardiovascular physiology with TMS. The electrocardiogram (ECG) and arterial pressure wave (APW) were coupled to triggering of cortical TMS in a patient with NVC-induced spinal accessory (CNXI) mononeuropathy. Outcome measures included motor evoked potential (MEP) amplitudes and firing probabilities of normal and affected trapezieus (TPZ). Values at intervals in proximity to the APW (40/80/120/160ms) were compared to baseline (800ms) using ANOVA and student t-test.

Results:

Electrocardiogram triggered TMS of CNXI pathways with 100% reliability. MEP amplitudes were decreased in proximity to the APW, particularly at 120ms (0.21±0.04 mV versus 0.39±0.10mV, p=0.003). TPZ firing probabilities were similarly inhibited (43.8% versus 88.2%, p=0.009). No effect of APW proximity was observed on the unaffected side (p=0.868). Procedures were well tolerated.

Conclusions:

Vascular compression causes CNXI mononeuropathy. Transcranial magnetic stimulation-cardiovascular coupling may evaluate neurovascular junction interactions and non-invasively diagnose NVC.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 36 , Issue 1 , January 2009 , pp. 83 - 88
Copyright
Copyright © The Canadian Journal of Neurological 2009

References

1.Wilkins, RH.Neurovascular compression syndromes. Neurol Clin. 1985;3:359–72.Google Scholar
2.Adams, CB.Microvascular compression: an alternative view and hypothesis. J Neurosurg. 1989;70:1–12.Google Scholar
3.Monstad, P.Microvascular decompression as a treatment for cranial nerve hyperactive dysfunction-a critical view. Acta Neurol Scand Suppl. 2007;187:30–3.Google Scholar
4.Kuncz, A, Voros, E, Barzo, P, Tajti, J, Milassin, P, Mucsi, Zet al.Comparison of clinical symptoms and magnetic resonance angiographic (MRA) results in patients with trigeminal neuralgia and persistent idiopathic facial pain. Medium-term outcome after microvascular decompression of cases with positive MRA findings. Cephalalgia. 2006;26:266–76.Google Scholar
5.Holley, P, Bonafe, A, Brunet, E, Simonetta-Moreau, M, Manelfe, C.[The contribution of “time-of-flight” MRI-angiography in the study of neurovascular interactions (hemifacial spasm and trigeminal neuralgia)]. J Neuroradiol. 1996;23:149–56.Google Scholar
6.Lunardi, P, Mastronardi, L, Farah, JO, De, BC, Trasimeni, G, Gualdi, GF.Spinal accessory nerve palsy due to neurovascular compression. Report of a case diagnosed by magnetic resonance imaging and magnetic resonance angiography. Neurosurg Rev. 1996;19:75–8.Google Scholar
7.Macchi, V, Porzionato, A, Parenti, A, De, CR.The course of the posterior inferior cerebellar artery may be related to its level of origin. Surg Radiol Anat. 2004;26:60–5.Google Scholar
8.Vincentelli, F, Caruso, G, Rabehanta, PB, Rey, M.Surgical treatment of a rare congenital anomaly of the vertebral artery: case report and review of the literature. Neurosurgery. 1991;28:416–20.Google Scholar
9.Kitagawa, M, Nakagawa, Y, Kitaoka, K, Kobayashi, N, Ishikawa, T, Nagashima, M.[Accessory nerve paralysis due to compression of the fenestrated vertebral artery]. No Shinkei Geka. 1988;16:1173–7.Google ScholarPubMed
10.Magoni, M, Scipione, V, Anzola, GP.Isolated accessory nerve palsy of unusual cause. Ital J Neurol Sci. 1994;15:241–3.CrossRefGoogle ScholarPubMed
11.Kikuchi, K, Kowada, M, Kojima, H.Hypoplasia of the internal carotid artery associated with spasmodic torticollis: the possible role of altered vertebrobasilar haemodynamics. Neuroradiology. 1995;37:362–4.Google Scholar
12.Pagni, CA, Naddeo, M, Faccani, G.Spasmodic torticollis due to neurovascular compression of the 11th nerve. Case report. J Neurosurg. 1985;63:789–91.Google Scholar
13.Shima, F, Fukui, M, Matsubara, T, Kitamura, K.Spasmodic torticollis caused by vascular compression of the spinal accessory root. Surg Neurol. 1986;26:431–4.Google Scholar
14.Berardelli, A, Priori, A, Inghilleri, M, Cruccu, G, Mercuri, B, Manfredi, M.Corticobulbar and corticospinal projections to neck muscle motoneurons in man. A functional study with magnetic and electric transcranial brain stimulation. Exp Brain Res. 1991;87:402–6.Google Scholar
15.Pelliccioni, G, Scarpino, O, Guidi, M.Magnetic stimulation of the spinal accessory nerve: normative data and clinical utility in an isolated stretch-induced palsy. J Neurol Sci. 1995;132:84–8.Google Scholar
16.O’Rourke, MF, Staessen, JA, Vlachopoulos, C, Duprez, D, Plante, GE.Clinical applications of arterial stiffness; definitions and reference values. Am J Hypertens. 2002;15:426–44.Google Scholar
17.Hess, CW.Central motor conduction and its clinical application. In: Magnetic stimulation in clinical neurophysiology. Hallet, M, Chokroverty, S, editors. Co 2005, Elsevier, Inc, Philadelphia, PA; page 86.Google Scholar
18.Hashimoto, M, Ohtsuka, K, Suzuki, Y, Minamida, Y, Houkin, K.Superior oblique myokymia caused by vascular compression. J Neuroophthalmol. 2004;24:237–9.Google Scholar
19.Yousry, I, Dieterich, M, Naidich, TP, Schmid, UD, Yousry, TA.Superior oblique myokymia: magnetic resonance imaging support for the neurovascular compression hypothesis. Ann Neurol. 2002;51: 361–8.Google Scholar
20.Hashimoto, M, Ohtsuka, K, Akiba, H, Harada, K.Vascular compression of the oculomotor nerve disclosed by thin-slice magnetic resonance imaging. Am J Ophthalmol. 1998;125:881–2.Google Scholar
21.Ohtsuka, K, Sone, A, Igarashi, Y, Akiba, H, Sakata, M.Vascular compressive abducens nerve palsy disclosed by magnetic resonance imaging. Am J Ophthalmol. 1996;122:416–9.Google Scholar
22.Zhu, Y, Thulborn, K, Curnyn, K, Goodwin, J.Sixth cranial nerve palsy caused by compression from a dolichoectatic vertebral artery. J Neuroophthalmol. 2005;25:134–5.Google Scholar
23.Wahlig, JB, Kaufmann, AM, Balzer, J, Lovely, TJ, Jannetta, PJ.Intraoperative loss of auditory function relieved by microvascular decompression of the cochlear nerve. Can J Neurol Sci. 1999;26:44–7.Google ScholarPubMed
24.Morini, A, Rozza, L, Manera, V, Buganza, M, Tranquillini, E, Orrico, D.Isolated hypoglossal nerve palsy due to an anomalous vertebral artery course: report of two cases. Ital J Neurol Sci. 1998;19:379–82.Google Scholar
25.Hilton, DA, Love, S, Gradidge, T, Coakham, HB.Pathological findings associated with trigeminal neuralgia caused by vascular compression. Neurosurgery. 1994;35:299–303.Google Scholar
26.Savk, O, Savk, E.Investigation of spinal pathology in notalgia paresthetica. J Am Acad Dermatol. 2005;52.1085–7.Google Scholar
27.Tacconi, P, Manca, D, Tamburini, G, Cannas, A, Giagheddu, M.Notalgia paresthetica following neuralgic amyotrophy: a case report. Neurol Sci. 2004;25:27–9.CrossRefGoogle ScholarPubMed
28.Kotterba, S, Tegenthoff, M, Malin, JP.Hemifacial spasm or somatoform disorder-postexcitatory inhibition after transcranial magnetic cortical stimulation as a diagnostic tool. Acta Neurol Scand. 2000;101:305–10.Google Scholar
29.Netter, FH.Cerebral vasculature. In: Atlas of human anatomy. Netter, FH, Colacino, S, editors. Co 1989 CIBA-GEIGY Corporation, West Caldwell NJ. plate 132.Google Scholar