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Forgotten Reflexes

Ciliospinal Reflex

Evaluated nerve roots C8-T2 and sympathetic outflowAbsent in Horners and cervical sympathetic lesions as well as brain deathMay be enhanced in patients with cluster headacheMore pronounced in sleep and comatose patientsUnaffected in 1st order sympathetic injury

Jaw Jerk Reflex

The response to the stimulus is monosynaptic, with sensory neurons of the trigeminal mesencephalic nucleus sending axons to the trigeminal motor nucleus, which in turn innervates the masseter

Pectoral Reflex

Pectoral - medial and lateral pectoral nerves, C5/6 (clavicular head) & C7/8, T1 (sternocostal head)Percussion at the deltopectoral grooveHyperactivity correlates with cord lesion at C2/C2 and C3/C4

Hoffman Reflex (Finger Flexors)

UMN sign

Reflective of C8-T1 reflex arc activity

Superficial Abdominal Cutaneous Reflex

Abdominal above umbilicus T8, T9, T10 Abdominal below umbilicus T10, T11, T12Loss of abdominal cutaneous reflexAbsent on the side contralateral to an upper motor neuron lesionUsually associated with hyperactive DTRs When isolated there is a loss of a reflex arc

Mesial Hamstring Reflex

Of all the lower extremity DTRs, the mesial hamstring reflex correlates best with an L5 radiculopathy

Cremasteric Reflex: BasicsReflex is elicited by stroking the mesial thigh causing an ipsilateral contraction of the cremasteric muscleBrings testicle closer to the external inguinal ringReflex test L1-L2 (genitofemoral nerve responsible for afferent and efferent limbs)Typically absent in testicular torsionNegative predictive value of over 90%

Cremasteric Reflex

Crossed Adductor Reflex

Often elicited with striking the contralateral quad tendonAlternative (and my preferred) striking hand that covers the mesial knee and watching for contralateral adductionTibioadductor reflex is a variant

Bulbocavernosis Reflex

Squeeze the head of the penis or the clitoris or tugging on a Foley catheter with resultant contraction of the anal sphincterDependent on S1-S3When spinal cord injury is present it is an indicator of spinal cord shockReturn of reflex suggests the end of spinal shockCan be one of the first reflexes to returnIn the absence of cord signs, it can indicated sacral nerve root injury

Glabellar Reflex

Often associated with Parkinsons diseaseProbably a frontal lobe release sign that can been seen in a number of dementing illness

Frontal Lobe Release Phenomenon

Snout ReflexPalmomental Reflex