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- Title
TMS Neuro-Cardiovascular Coupling in Vascular Compression Cranial Neuropathy.
- Authors
Kirton, Adam; Gunraj, Carolyn; Chen, Robert
- Abstract
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.
- Subjects
TRANSCRANIAL magnetic stimulation; EVOKED potentials (Electrophysiology); NEUROPATHY; ALTERNATIVE medicine; NEUROPHYSIOLOGY; ELECTROCARDIOGRAPHY
- Publication
Canadian Journal of Neurological Sciences, 2009, Vol 36, Issue 1, p83
- ISSN
0317-1671
- Publication type
Article
- DOI
10.1017/S0317167100006363