Use of reflexes in the neurological exam to guide clinical assessment with an emphasis on the more obscure and less frequently used tests

1. Forgotten Reflexes

2. Ciliospinal Reflex
 Evaluated nerve roots C8-T2 and
sympathetic outflow
 Absent in Horner’s and cervical
sympathetic lesions as well as brain
death
 May be enhanced in patient’s with
cluster headache
 More pronounced in sleep and
comatose patients
 Unaffected in 1st order sympathetic
injury

3. 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

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

5. Hoffman Reflex (Finger Flexors)
UMN sign
Reflective of
C8-T1 reflex arc
activity

6. Superficial Abdominal Cutaneous
Reflex
 Abdominal above umbilicus
 T8, T9, T10
 Abdominal below umbilicus
 T10, T11, T12
 Loss of abdominal cutaneous reflex
 Absent on the side contralateral to an
upper motor neuron lesion
 Usually associated with hyperactive
DTRs
 When isolated there is a loss of a
reflex arc

7. Mesial Hamstring Reflex
Of all the lower extremity DTRs, the mesial
hamstring reflex correlates best with an L5
radiculopathy

8. Cremasteric Reflex: Basics
 Reflex is elicited by stroking the mesial thigh causing an ipsilateral
contraction of the cremasteric muscle
 Brings testicle closer to the external inguinal ring
 Reflex test L1-L2 (genitofemoral nerve responsible for afferent and efferent
limbs)
 Typically absent in testicular torsion
 Negative predictive value of over 90%

9. Cremasteric Reflex

10. Crossed Adductor Reflex
 Often elicited with striking the
contralateral quad tendon
 Alternative (and my preferred) striking
hand that covers the mesial knee and
watching for contralateral adduction
 Tibioadductor reflex is a variant

11. Bulbocavernosis Reflex
 Squeeze the head of the penis or the
clitoris or tugging on a Foley catheter
with resultant contraction of the anal
sphincter
 Dependent on S1-S3
 When spinal cord injury is present it is
an indicator of spinal cord shock
 Return of reflex suggests the end of
spinal shock
 Can be one of the first reflexes to
return
 In the absence of cord signs, it can
indicated sacral nerve root injury

12. Glabellar Reflex
 Often associated with
Parkinson’s disease
 Probably a frontal lobe
release sign that can been
seen in a number of
dementing illness

13. Frontal Lobe Release Phenomenon
Snout Reflex Palmomental Reflex