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Cranial nerves
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
Perform the jaw jerk reflex by placing a finger below the lips of the patient, on the mandible, and lightly striking this with a tendon hammer. The patient should have their mouth slightly open. If positive, the jaw should jerk upwards.
Brain death and ethical issues: Death by neurological criteria
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Brittany Bolduc, David M. Greer
After confirming a comatose state, the physician can move on to cranial nerve testing. All cranial nerve reflexes must be absent for the diagnosis of brain death. Pupillary response to a bright light must be absent in both eyes. The pupils are typically fixed in mid-position (4–9 mm) due to sympathetic and parasympathetic denervation (4). Pinpoint pupils should alert the provider to possible drug effect. A magnifying glass or pupilometer may be used to detect small changes in pupil size. In a patient with proper spinal integrity, oculocephalic reflexes should be tested by rapidly turning the patient's head from side to side and vertically with the eyes held open. There should be no eye movement in the brain-dead patient. Vestibuloocular reflexes should be tested using maximal ice water caloric stimulation. First, otoscopic examination is performed to ensure that tympanic membrane is intact and external auditory canals are patent. The head of the bed should be at 30°. Fifty mL of ice water is infused into one ear through a flexible, dull-ended tube, such as a butterfly catheter with the needle removed. The infusion occurs over 1 minute, while an assistant holds open the patient's eyes. A patient who is brain dead will display no response to this test, including no grimace, eye movements, or motor response. An interval of 5 minutes should exist before testing the other ear (17). The corneal reflex should be tested with a cotton swab applicator pressed carefully on the cornea bilaterally. Facial muscle response to noxious stimuli should be assessed by applying deep pressure to the temporomandibular joint and the supraorbital ridge. No grimace should be seen. Gag and cough reflexes can be tested by suctioning the patient's endotracheal tube or by stimulating the posterior pharynx with a tongue depressor. A jaw jerk reflex should be absent. Again, all cranial nerve reflexes must be absent bilaterally in order to diagnose brain death and to proceed with further testing.
A case of vertebral artery compression syndrome mimicking primary lateral sclerosis
Published in International Journal of Neuroscience, 2022
Huimin Cai, Bin Zhang, Biao Huang, Lijuan Wang, Limin Wang
A 65-year-old right-handed man with a history of hypertension was referred to our neurology department in the suspect of possible PLS by the referring neurologist. The patient presented with a 10-year history of involuntary jerk characterised by brisk extension of the left lower extremity while he was sitting. Seven years after onset, he developed intermittent painful spasms with a tendency to drag his left leg. In the preceding year, his symptoms progressed to the left upper extremity marked by brisk flexion of the elbow, causing difficulty holding objects occasionally. He reported the symptoms aggravated with higher blood pressure and attenuated with optimal blood pressure. He also noticed the symptoms were worse when he lied down. He was able to walk independently without any assistance. There was no family history of neurodegenerative diseases. Neurological examination revealed upper motor neuron signs. The patient had generalized bilateral hyperreflexia and sustained left-sided ankle myoclonus. Jaw jerk reflex and Hoffman’s sign were absent. Babinski’s sign and Chaddock’s sign were positive in the left lower limb. He had increased muscle tone in the left extremities with spasticity, but normal muscle tone in the right extremities. Subtle pyramidal weakness (Medical Research Council (MRC) grade 4+) was noted in the left extremities. Muscle atrophy, fasciculation, sensory deficits, and cerebellar signs were not detected.
Three different short-interval intracortical inhibition methods in early diagnosis of amyotrophic lateral sclerosis
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2023
Hatice Tankisi, Hossein Pia, Kristine Strunge, James Howells, Bülent Cengiz, Gintaute Samusyte, Martin Koltzenburg, Anders Fuglsang-Frederiksen, Hugh Bostock
The disease duration in months from time of symptom onset and the disease onset as bulbar, upper or lower extremity spinal, were noted for all patients. All patients received a detailed clinical examination. The UMN involvement was graded using a modified Penn UMN score (UMNS), which ranged from 0 to 27, with higher scores corresponding to greater disease burden (17). For this study, single points were given for an abnormal jaw-jerk reflex, palmomental sign, and central nervous system lability scale, and in the extremities, the deep tendon reflexes, pathological reflexes (Hoffman’s and Babinskís sign and clonus) and spasticity were evaluated.
Influence of mouth and jaw movements on dynamics of spontaneous eye blink activity assessed during slitlamp biomicroscopy
Published in Clinical and Experimental Optometry, 2018
Similarly, it has been noted that there could be links between the eye blink reflex and jaw‐stretch reflex,2006 with jaw and blink reflexes coupled to the trigeminal system.1985 Synchronisation of orbicularis oculi and orbicularis oris responses to electrical stimulation can occur,2013 with such interactions between these muscle group activities occurring because of some common innervation pathways.2004 Jaw jerk reflex to chin taps can be correlated with blink reflex to glabella taps.1982