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Dementia
Published in Henry J. Woodford, Essential Geriatrics, 2022
The frontal release signs are neurological phenomena that originate from the brainstem or below. These signs are present in newborn children until subcortical myelination is completed. They may recur in later life in healthy individuals or in association with cerebral damage.9 They are then termed ‘release' signs due to the loss of the cortical inhibition of the brainstem-mediated mechanisms. They have been detected in 55% of people with AD (mean age 68 years) compared to 9% of healthy control subjects (mean age 62).22 In general, their occurrence does not correlate well with cognitive function.Grasp reflex: the patient grasps an object that is stroked across their palm.Pout (snout) reflex: a pouting facial expression is produced when the area lateral to the upper lip is stroked.Glabellar tap: the area between the eyebrows is gently tapped (with the examiner's arm approaching from above/behind to prevent blinking to a threatening stimulus). A positive result is achieved when the patient continues to blink beyond the first three taps.
Discussions (D)
Published in Terence R. Anthoney, Neuroanatomy and the Neurologic Exam, 2017
A second reason that some authors use the term “pathologic reflexes” so narrowly seems to involve attempts to subdivide the “abnormal” reflexes into clinically meaningful subgroups. For example, Massey, Pleet, and Scherokman (1985) specifically define “pathologic reflexes” as “indicators of a pyramidal tract lesion” (p. 64), while labelling some other abnormal reflexes (e.g., sucking, ipsilateral palmomental, and grasp reflexes)—presumably indicative of extensive frontal- lobe damage—as “frontal release signs” (p. 68–71). Some other authors also distinguish a category Called “frontal release signs” or “primitive reflexes” (see D: Primitive reflexes for an ambiguity related to that term), but the particular reflexes listed vary somewhat among texts (compare, for example, DeJ, p. 486–487, to MP&s p. 70–71). Other categories of abnormal reflexes may also be found, such as the “reflexes of spinal automatism” (= “defense reflexes”) described by DeJong (1979, p.464–467).
Motor Neurological Examination of the Hand and Upper Limb
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
are less constant, more difficult to elicit and usually less significant diagnostically then lower extremity reflexes. They are mainly of two types:Forced grasping or grasp reflex (GR) is known to be a primitive reflex not normally seen in adults and is caused by a pathological lesion located in the frontal lobe.A positive GR is defined as forced grasping of the examiner's hand by the patient in response to the examiner touching the patient's palm between the thumb and index finger. When a patient unintentionally grasps a visually presented object, it is called a groping reflex. Forced grasping and groping are usually performed by the hand contralateral to a destructive lesion in the frontal lobe, such as a lesion in the supplementary motor area (Brodmann area 6) or frontal-orbital area (Brodmann area 8).The palmomental reflex (PMR) is a primitive reflex consisting of a twitch of the chin muscle elicited by stroking a specific part of the palm. It is present in infancy and disappears as the brain matures during childhood but may reappear due to processes that disrupt the normal cortical inhibitory pathways. Therefore, it is an example of a frontal release sign. This sign can be elicited by stroking the thenar eminence with a thin stick, from the wrist to the thumb base using moderate pressure. If there is a single visible twitch of the ipsilateral mentalis muscle, it is considered a positive response.
HD-tDCS as a neurorehabilitation technique for a case of post-anoxic leukoencephalopathy
Published in Neuropsychological Rehabilitation, 2022
Sarah Garcia, Benjamin M. Hampstead
Given the widespread injury that occurs with PAL, it is unsurprising that cognitive deficits have been reported in virtually all domains including attention, language, executive function, and learning and memory (Anderson & Arciniegas, 2010; Shprecher & Mehta, 2010; Victor & Ropper, 2001). Associated personality and behavioural changes can be wide-ranging but often include emotional lability, impulsivity, and irritability (Anderson & Arciniegas, 2010). In more severe cases, PAL can also lead to frontal release signs and symptoms typically seen in psychosis (Shprecher & Mehta, 2010).
The palmomental reflex in amyotrophic lateral sclerosis – a clinical sign of executive or motor dysfunction?
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2021
Maximilian Vidovic, Elisa Aust, Andreas Hermann, René Günther
Of note, executive functions are not only associated with the prefrontal cortex but also with non-frontal cortical and subcortical regions, in line with the presence of dysexecutive symptoms in multifocal neurodegenerative diseases such as Parkinson’s disease or dementia on which high prevalence of PMR has been reported (7,8,14,15). Therefore, executive impairment might not be specific for frontal lobe lesions and in this context, PMR might not only be a “frontal release sign”. Due to the relatively small sample size, these results have to be confirmed in larger studies.
Hyper-religiosity and visual hallucinations in a patient with frontotemporal dementia carrying a double variant in GRN gene
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2022
Maurizio Morelli, Andrea Quattrone, Gennarina Arabia, Ida Manna, Antonio Gambardella, Aldo Quattrone
In the following years, the patient showed a slow but progressive worsening of hyper-religious behavioral disturbances. She spent the whole day in religious practices as praying, meditating, and reading religious texts and developed perseverative, stereotyped and compulsive behaviors like making the sign of the cross or joining hands in prayer. Indeed, she collected figures of Saints and religious magazines and started exhibiting signs of hypergraphia with excessive compulsive writing of religious topics. Five years after symptoms onset (July 2017), the patient began to present visual hallucinations of exclusive religious nature and she reported seeing Virgin Mary, Jesus and several Saints every day. The visual hallucinations persisted even after treatment with clozapine (75 mg/day). In September 2020, she developed loss of empathy with insensitivity and lack of interest toward family members, and showed reduced social interactions. The new neuropsychological examination revealed difficulties with attention and working memory. Significant deficits in executive tasks as problem solving, set shifting, mental flexibility, response inhibition, and abstract reasoning were evident. The spontaneous language output was fluent with exclusive religious content, whereas other language skills, including auditory comprehension, repetition, writing, and reading were intact. Tests for episodic memory, face recognition, visuospatial skills were normal. The neurological examination revealed frontal release signs, including grasp and palmo-mental reflexes. EEG recording (October 2020) showed diffuse slow theta-delta waves, whereas EMG (November 2020) was unremarkable. Brain 3T MR imaging performed 8 years after the initial scan (January 2021) showed only mild worsening of bilateral frontotemporal atrophy with left-side predominance (Figure 1(C,D)). One month later (February 2021), a 18F-fluorodeoxyglucose-positron emission tomography (18FDG-PET) confirmed hypometabolism in bilateral frontal and anterior temporal lobes temporal that was more severe in the left side (Figure 1(E,F)). Patient and family declined cerebrospinal fluid analysis. The brain MR imaging and 18FDG-PET findings, along with her clinical features, were consistent with the diagnosis of bv-FTD. We detected neither mutations in MAPT nor expansion in C9orf72 whereas we found the simultaneous presence of p.Cys139Arg variant and c.*78C > T variant in the GRN gene. The patient and her caregiver gave written consent to participate in the study. This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Magna Graecia University of Catanzaro, Italy.