Trunk reflexes
__bezobsahu__
Trunk reflexes correspond to the intactness of a certain part of the trunk. Basically these are unconditioned reflexes and their examination does not require the cooperation of the patient. This is especially beneficial in a situation where it is necessary to evaluate neurological findings in an unconscious person . Examination of the trunk and diencephalic reflexes is usually preceded by the determination of the level of consciousness using the Glasgow Coma Scale . In people with an altered neurological condition, clinical diagnosis is quite complicated. The equipment of the trunk reflexes makes it possible to specify the vertical localization of the problem, as well as the possible progression or regression of the condition.
Reflexes are always examined in craniocaudal order (see table). The last non-equipped reflex and the first equipped reflex determine the lowest level of trunk disability. Trunk reflexes tend to be symmetrically preserved n metabolic, anoxic and toxic bilateral impairments of the hemispheres. It gradually disappears during the progression of the craniocaudal deterioration syndrome. They are renewed in the same order when the syndrome recedes, no later than the end of the second week. A delay in recovery indicates a secondary complication of the condition, such as infection or intracranial hypertension . Reflexes are unilaterally affected in unifocal lesions.
| Etáž Trunk floor | Reflex | Equipment | Expected reaction | Extinction | Benefit |
|---|---|---|---|---|---|
| diencephalon | ciliospinal | strong pressure of the skin in the upper bud | unilateral pupil dilation | lesions of the midbrain, trunk and cervical spinal cord | equipment together with other trunk reflexes indicates a disorder of consciousness conditioned by a lesion in the cortex-subcortex plane |
| diencephalon-mesencephalon | nasopalpebral (frontoorbiokular) | tap on the glabella | slow contraction of the upper parts of the orbicularis oculi muscle | lesion of the mesencephalon-midbrain reticular formation extinguishes  |
equipped on both sides at the onset of the awakening reaction; if it is not present half a year after the correction of the coma - probable irreversible structural damage to the cerebral cortex |
| diencephalon-mesencephalon | oculocephalic vertical | repeated head movements head tilt-forward head tilt | conjugate movement of the bulbs in the opposite direction (baby–doll response) = when the head is tilted, the patient looks down | damage to the vestibulo-ocular structures | they cannot be recalled when fully conscious, they are inhibited from the visual centers
paralysis of the vertical reflex with preserved horizontal = bleeding into the thalamus and compression of the upper part of the brainstem |
| mesencephalon-pons (middle mesencephalon) | pupillary | unilateral illumination of the eye | standard reaction = constriction of the pupil ipsilaterally (direct reflex) and contralaterally (indirect reflex) | ||
| mesencephalon-pons (superior pons) | corneal | unilateral irritation of the cornea with a piece of cotton wool | standard reaction = closing the lids of both eyes (again direct and indirect depending on the side) | lesions of the trigeminal nerve , facial nerve , and oculomotor nerve | bilaterally incapacitated with severe brainstem damage |
| mesencephalon-pons (middle pons) | masseteric | tap the mallet over the finger on the center of the chin with the mouth slightly open | contraction of the masticatory muscles | death in deep coma due to muscle atony, hyperreflexia is common in coma | |
| mesencephalon-pons (inferior pons) | oculocephalic horizontal | movement of the patient's head from right to left | conjugate movement of the bulbs in the opposite direction = I turn the head to the left - the patient looks to the right | secondary = diffuse damage to the hemispheres
unilateral = occlusion of the basilar artery , bleeding into the cerebellum, hematomas of the posterior cranial fossa bilateral = primary lesion of the pons, barbiturate poisoning, transtentorial herniation dissociation = oculomotor nerve palsies||accessory/hyperactive = primary hemispheric structural lesion or diffuse hemispheric damage (excludes trunk involvement at the level of the oculomotor nuclei) unilateral disappearance = homolateral lesion of the abducens nerve | |
| pons-bulbus | oculocardiac | finger pressure on the bulbs with closed eyes | slowing of the heart rate, present repeatedly, min. o 15 beats/min |
pons lesion, trigeminal nerve lesion (orbital fractures) | maximum reflex response in the first 20 seconds; when fully conscious, it is accompanied by nausea, the presence of only this reflex is a sign of an unfavorable prognosis |
| medulla oblongata | cough and gag reflex | we do not deliver on purpose | gagging/coughing during insertion of the endotracheal tube |
