NeuroTeach 1 - Superficial (Cutaneous) Reflexes

The arcane superficial reflex!!!

“response to stimulation of either the skin or mucous membrane” - polysynaptic, slow, longer latency, easily fatigable - abolished by pyramidal tract lesions

2) Palmar reflex “stroking palm of hand is followed by flexion of fingers or closing of the hand”

3) Scapular reflex

“scratching the skin over the scapula/interscapular space causes contraction of scapular muscles”

4) Cremasteric reflex

“stroking the skin on inner aspect of the thigh cause contraction of the cremasteric muscle (elevate homolateral testicle)”

5) Cremasteric reflex ≠ Dartos reflex

Dartos reflex is a sympathetically mediated reflex “evoked ipsilaterally by local cold on the scrotum, and produces a slow, writhing, vermicular contraction of the scrotal skin together with testis elevation”

6) Gluteal reflex

“contraction of gluteal muscles due to stroking the skin over the buttocks”

7) Plantar reflex

“stroking plantar surface of the foot from the heel forward is normally followed by plantar flexion of the foot and toes”

8) Plantar reflex ≠ extrapyramidal plantar flexion

Extrapyramidal plantar flexion “tonic plantar reflex with slow, prolonged contraction” - frontal lobe - extrapyramidal diseases

9) Anal reflex (anal wink) “contraction of external sphincter in response to stroking the skin in the perianal region”

10) Bulbocavernosus reflex

“stimulus delivered to glans penis/clitoris lead to contraction of the anal sphincter”

11) Abdominal reflex

“stroke of anterior abdominal wall lead to contraction of the abdominal muscles” Can be divided into: - Epigastric reflex - Umbilical reflex (upper/lower abdominal reflexes)

12) Epigastric reflex

“elicited by a stimulus moving from the xiphoid toward the umbilicus; there is usually no retraction or movement of the umbilicus”

13) Umbilical reflexes

“light stroking in each quadrant elicits the response, pulling the umbilicus in the direction of the stimulus”

14) Umbilicus is T10

‘T10 for belly but-ten’ (upper) supraumbilical reflexes -> T7 – T10 (lower) infraumbilical reflexes -> T10 – upper lumbar segments

15) Bechterew’s hypogastric reflex

“stroking the skin on the inner surface of the thigh causes contraction of the homolateral lower abdominal muscles”

16) Rosenbach’s sign

“absence of superficial abdominal reflexes” First described in hemiparetic individuals by German physician Ottomar Ernst Felix Rosenbach (1851 – 1907)

17) Rosenbach’s sign

“absence of superficial abdominal reflexes”

18) Dissociation of the abdominal reflexes

“absent superficial and exaggerated deep reflexes” - pyramidal lesion - affects first the lower quadrant - in scoliosis, it suggests syringomyelia

19) Dissociation of the abdominal reflexes

“absent superficial and exaggerated deep reflexes”

20) Dissociation of the abdominal reflexes

“absent superficial and exaggerated deep reflexes”

21) Dissociation of the abdominal reflexes

“absent superficial and exaggerated deep reflexes”

22) Beevor's sign

“movement of umbilicus in supine attempting to flex the head” - classified by some as part of cutaneous investigation - weakness of upper part of rectus abdominis - spinal lesions and myopathies

23) Beevor's sign

“movement of umbilicus in supine attempting to flex the head”

24) Some authors categorize

- Corneal reflex - Conjunctival reflex - Ciliospinal reflex - Pupillary reflex as superficial reflexes too

25) Reflex patterns with different neurologic disorders

26) Inverted Beevor sign "predominant weakness of upper rectus abdominis muscle"