Flash Visual Evoked Potential Recording in Patients with Brain Stroke.

Seyedehsaba Ameli¹, Ali Panahi sharif¹, Sanaz saleh¹, seyed Mohammad Masoud Shushtarian^2*, Ahmad Shojaei³

¹Department of Medical Sciences, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran

²Department of Biophysics and Biochemistry, Faculty of Advance Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran

³Basir Eye Health Research Center, Iran University of Medical Sciences, Tehran, Iran

^*Corresponding author: seyed Mohammad Masoud Shushtarian, Department of Biophysics and Biochemistry, Faculty of Advance Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.

Received: 26 June 2023; Accepted: 03 July 2023; Published: 12 July 2023

1. Introuduction

Brain Stroke is a catastrophic event that can damage various organs of the body, including the visual system. Electrophysiology of vision is a diagnostic technique used to assess different pathological conditions of the visual system, primarily the visual pathway and retina. Electroretinography (ERG), Electrooculography (EOG), and visual evoked potential (VEP) are commonly employed electrophysiological techniques in this field. Abdolalizadeh et al. (2022) conducted a study to investigate the potential effects of antiseizure medication on patients using ERG. The study included twenty participants, consisting of ten males and ten females, ranging in age from 15 to 30 years. The findings revealed retinal changes in these patients, which were diagnosed by measuring the amplitude of ERG, specifically b-wave peak [1]. The same research group also examined the retinal pigment epithelium (RPE) of patients undergoing treatment with anti-epileptic medication using EOG. They utilized the same group of patients and observed pathological changes in the RPE, which were identified by assessing the Arden index (AI) of EOG test [2]. Shushtarian et al. (2017) designed a study to investigate the potential effects of vibration on the visual pathway using VEP. They selected 50 workers from a textile factory segment where machinery creating high levels of vibration. The study concluded that occupational vibration had adverse effects on the visual pathway, leading to increased latency of VEP, specifically the P100 peak [3]. Numerous references have been published on this topic [4-37]. In the present work, we utilized flash type VEP to screen the visual pathway of patients who had suffered a brain stroke. Flash type stimulation was chosen due to the reduced visual acuity in most patient, making it difficult for them to discern the fixation point required for recording pattern-type stimulation. Although VEP is a suitable technique for screening the visual pathway in stroke patients [38-40], there exist conflicting findings that will be discussed in the later sections of this manuscript.

2. Patients and Methods:

In this case control study, thirteen patients with brain attack (6 male and 7 female), regardless of the type of stroke, were referred to Basir Eye Clinic for VEP examination to assess possible visual dysfunction. The age range of the patients was 55 to 70 years. Visual acuity was tested and ranged from 1/10  to 4/10 (BCVA). Visual evoked potential (VEP) with flash stimulation method was performed to evaluate the visual pathway of the patients. The latency (msec) and amplitude (µv) of of the P100 peak in VEP were measured for all patients using the Mangoni machine. To connect the machine to the patients three electrodes were used: one attached to the occipital region as the active electrode, one to the vertex as the reference electrode, and one to the forehead as the ground electrode.The same procedure was repeated for 13 healthy individual, matched in terms of age and sex, serving as the control group for comparison with the patient group. These individuals were selected based on their intact visual system, particularly the visual pathway.The obtained results from the two groups were compared to identify any differences between them.

3. Results:

Table1: demographical findings in case and control groups.

Table 2: Measurement of the mean latency and amplitude of the P100 peak in visual evoked potentials (VEP) was conducted in both case and control groups.

There was no statistically significant between the two groups regarding age (P value = 0.88*) and sex (0*), whereas a significant difference was observed in BCVA (P < 0.001).

Table 2 presents the measurement for latency and amplitude of VEP P100 peaks in the control and case groups. There was statistically significant difference in the latency and amplitude of VEP P100 peaks between the healthy and patient groups (P100 < 0.0.1 for both groups).

4. Discussion

Stroke is a heterogenous syndrome and a leading cause of death and disability worldwide.

The visual system, particularly the visual pathway, may be affected during a stroke episode. VEP is a technique used to assess visual pathway disturbances, and it was employed in this study to investigate potential changes in the visual pathway.The findings demonstrated prolonged latency and reduced amplitude of the VEP P100 peak, providing evidence of visual pathway disturbances in these patients. The following references may supports the findings of the present study: Pojda- Wilczek D et al. (2015) conducted a relevant study where they evaluated VEP using flash-type stimulation in various patient with brain circulatory problems, including those with hemianpsia, quadratanpsia and hemiparesis after a stroke. Their result indicated an increase in latency and a decrease in amplitude of the VEP P100 peak in the patients [41]. Gaffat Al-Nasriwy SZ (2018) investigated the utility of VEP in stroke patients with a focus on sensitivity and specificity. The results demonstrated a sensitivity of 25.9% and a specificity of 100% (P value < 0.01, highly significant). Among all patients, 26% exhibited abnormal VEP P100 peak being the most common abnormality [42]. In addition to the above two references, there is a study suggesting that stroke does not produces changes in VEP test [41]. It is worth noting that the authors of that study employed pattern stimulation, whereas the present study used flash-type stimulation.

5. Conclusion

Stroke can affect the visual pathway of patients, as evidenced by alterations in the latency and amplitude of the VEP P100 peak during flash VEP testing.

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