Corneomandibular reflex!!!

“there is hardly a more valuable test than this to uncover a supranuclear lesion of the trigeminal nerve”

Russian neurologist Robert Wartenberg (1887–1956)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
History

1902 by German doctor Von Sölder
- first description, normal patients

1918 by German neurologist Ernst Trömner
- rediscovered the reflex

1948 by Russian neurologist Robert Wartenberg
- complete description
- ‘jaw wincking phenomenon’

2/
Pathophysiology

Mesencephalic trigeminal nucleus
- there is an inhibitory interneuron ipsilateral motor nucleus of V CN

Lesions in cortico-pontine boundaries lesions
- inhibitory influence disappear
- massive activation of trigeminal motor neuron

doi.org/10.4103%2F0976…

3/
Corneomandibular reflex

representation in pediatric and adult individuals

4/
Corneomandibular reflex

“stimulation of cornea causes contralateral movement of the mandible”

- usually associated movement > reflex
- supranuclear interruption of ipsilateral corticotrigeminal tract
- ALS

5/
Corneomandibular reflex

“stimulation of cornea causes contralateral movement of the mandible”

- usually associated movement > reflex
- supranuclear interruption of ipsilateral corticotrigeminal tract
- ALS

via: Neurology Made Interesting

6/
Corneomandibular reflex

“stimulation of cornea causes contralateral movement of the mandible”

- usually associated movement > reflex
- supranuclear interruption of ipsilateral corticotrigeminal tract
- ALS

via: JAMA Network

7/
Corneomandibular reflex

“stimulation of cornea causes contralateral movement of the mandible”

- usually associated movement > reflex
- supranuclear interruption of ipsilateral corticotrigeminal tract
- ALS

youtube.com/shorts/jaxIwN-… via: Primeesha Medical Zone

8/
Other frontal release signs

Palmar grasp, palmomental, rooting & sucking, snout, glabellar, and head retraction reflex



9/

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More from @theneurolander

Nov 23
Movement disorders specialists, I would appreciate your opinion.
A patient sent me this video.
I found the movements too quick and too high amplitude to be polyminimyoclonus.
What are your opinions about this movement?
@AlbertoEspay @SanjayP30043502 @AbhiLenka11 @JackyGanguly
MYBPC1 mutation are associated with myogenic tremor and mild myopathy

doi.org/10.1002/ana.25…
MYBPC1 mutation are associated with myogenic tremor and mild myopathy

doi.org/10.1002/ana.25…
Read 5 tweets
Nov 23
Nystagmus series – Part VI
(periodic alternating nystagmus, PAN)

“Nystagmus processor for EEG machines”

Italian-American neurologist Joseph Toglia (1927 – 2018)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials @TempleUniv

1/ Image
Definition

“horizontal nystagmus reverses direction every 2 minutes”

During transition period
-upbeating, downbeating, square-wave jerks can occur

- acquired form is rare, but it is the best understood and the first to have effective treatment

2/ Image
Pathophysiology

“lesion in cerebellum nodulus & uvula”

nodulus & uvula
- responsible for velocity-storage mechanism
- inhibitory control on vestibular rotation using GABA (baclofen-responsive)

vestibular system
- repair mechanism
- reverse direction of nystagmus

3/ Image
Read 21 tweets
Nov 21
Eye of the Tiger Sign

Clinical Correlate: Neurodegeneration With Brain Iron Accumulation Type 1

2/ Mulroy E, Balint B, Adams M...
Face of the Panda Sign

Clinical Correlate: Wilson's Disease

3/ Mulroy E, Balint B, Adams M...
Read 35 tweets
Nov 21
Polyminimyoclonus!!!

“intermittent, low-amplitude, arrhythmic movements of the hands, with amplitudes just sufficient to produce visible movements of the joints.”

American child neurologist Alfred J. Spiro (1930–2019)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Features

- Mostly noticed when maintaining a posture (outstretched hands) or during action (initial phase of the movement)

2/
Pathophysiology @JackyGanguly

Motor cortex
- execution of fractionated muscle activation

Anterior horn cells
- generators of complex fasciculation

Possible role of brainstem, cerebellum, and basal ganglia

3/
Read 24 tweets
Nov 21
Nystagmus series – Part V
(torsional/rotatory nystagmus)

“the only ophthalmologist 'who practiced ophthalmology' to win a Nobel Prize”

Swedish ophthalmologist Allvar Gullstrand (1862–1930)
(dioptrics of the eye)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials
1/ Image
Pathophysiology

“lesions in midbrain and medulla”

Central
- pure torsional: medulla (pontomedullary junction)
- up/down: midbrain (rostral interstitial nucleus of the medial longitudinal fasciculus)

Peripheral
- horizontal: anterior and posterior semicircular canals

2/ Image
Fixation in central vestibular nystagmus

“poorly suppressed by fixation of a visual target”

- abnormal smooth-pursuit system



3/
Read 18 tweets
Nov 20
Nystagmus series – Part IV
(upbeat nystagmus)

“Bruns ataxia, Bruns syndrome, Bruns law, Bruns nystagmus”

German neurologist Ludwig Bruns (1858–1916)

#MedTwitter #neurotwitter #EndNeurophobia #tweetorials

1/
Pathophysiology

“lesions from medulla to midbrain”

Caudal medulla
-nucleus intercalatus; nucleus of roller; nucleus of paraphales

Midbrain
-ventral tegmental tract (connection between vestibular nuclei & semicircular canals)

Rostral pons & medullar
-brachium conjunctivum

2/
Fixation in central vestibular nystagmus

“poorly suppressed by fixation of a visual target”

- abnormal smooth-pursuit system



3/
Read 18 tweets

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