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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.
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Abstract

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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

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