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Deep abdominal reflexes were recorded electromyographically in six patients with lesions of the upper motor neuron. The responses were bilateral, usually with identical latencies which ranged from 16.5 to 25 ms. Individual variation was never greater than 2 ms. It is postulated that these bilateral responses of abdominal muscles were independent stretch reflexes and were not mediated across the midline through an intraspinal pathway.
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Examination of the superficial abdominal reflexes in patients thought to have idiopathic scoliosis has been considered possibly beneficial for deciding who should have magnetic resonance imaging to rule out syringomyelia. The purpose of this study was to determine what is normal for this examination. Thirty normal adolescents and 35 normal young adults underwent testing of the superficial abdominal reflexes and the patellar and Achilles deep tendon reflexes. Each test was repeated two times. Thirty-nine (60%) subjects had bilaterally equal abdominal reflexes. Nine (14%) subjects had asymmetric reflexes, and seven (11%) subjects had no reflex in at least one quadrant. No subjects had reflexes present on one side and absent on the other. Ten (15%) subjects had absence of the abdominal reflexes in all quadrants. Sixteen (25%) subjects had extinguishing of the reflex in at least one quadrant as the test was repeated. Eleven of these had asymmetric or partially absent reflexes initially. In contrast, the patellar and Achilles reflexes were more consistent. The patellar reflexes were bilaterally equal in 52 (85%), asymmetric in eight (13%), and absent in one (2%). The Achilles reflexes were bilaterally equal in 59 (97%), asymmetric in one (2%), and absent in one (2%). The finding of abdominal reflexes consistently present on one side and consistently absent on the other side did not occur in our normal subjects. This finding might warrant further workup if found in a patient with scoliosis. Other variations in abdominal reflex testing such as asymmetries, absent in some quadrants, and absent in all quadrants are fairly common in normal subjects.
The deep tendon reflexes (and the abdominal reflexes) are important physical signs which have a special place in neurological diagnosis, particularly in early disease when they alone may be abnormal. They act as "hard" signs in situations where clinical assessment is complicated by patient anxiety, and become more useful as clinical experience develops.
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We studied the superficial abdominal reflexes of 83 normal men, using as stimuli a train of electrical pulses or a needle scratch. Electrical stimulation delivered to the midline of the abdominal wall evoked, almost symmetrically on both sides, two reflex discharges: an early response having an oligophasic wave form, and a late response of polyphasic wave form. The threshold of the early response significantly exceeded that of the late response. With repetitive stimulation, the late response generally revealed habituation. Electrical stimulation of the unilateral abdominal wall evoked two responses on the stimulated side, whereas it evoked only the late response on the contralateral side. A needle scratch on the unilateral abdominal wall evoked one reflex discharge with a long latency and a polyphasic wave form. This response occurred generally on the stimulated side and became habituated to repeated scratching. These observations suggest that the superficial abdominal reflexes elicited by electrical stimulation are composed of two reflex discharges with a different reflex arc. They appear to closely resemble the blink reflex. The response elicited by needle scratching is thought to correspond to the late response of the electrically elicited abdominal reflexes.
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To determine prevalence and significance of abnormal superficial abdominal reflexes (SARs) in idiopathic scoliosis. Study of 73 patients with presumed idiopathic scoliosis referred for magnetic resonance imaging (MRI), either as a routine pre-operative assessment (n=42) or because of abnormal symptoms or neurological signs (n=31). All patients were examined prior to magnetic resonance imaging (MRI), and the presence of abnormal SARs was noted. All patients then underwent MRI of the whole spine from the foramen magnum to the sacrum. The presence of Chiari 1 malformation and syrinx was recorded. The study group consisted of 11 males and 62 females with a mean age at time of MRI of 18 years (range 5-51 years) and a mean Cobb angle of 48 degrees (range 10-104 degrees). Abnormality of the SARs was recorded in eight cases (prevalence 11%). An abnormal MRI study was recorded in nine cases (12.3%), all patients having a syrinx and four having in addition, a Chiari 1 malformation. Of the patients with abnormal SARs, only 2 (25%) had an abnormal MRI study; 1 had unilateral absence of the reflexes whereas the other had complete absence of SARs. Of patients referred for MRI as a routine pre-operative assessment, 5 (11.6%) had an abnormal MRI study. In patients with idiopathic scoliosis, abnormality of the SARs was recorded in 11% of cases. Unilateral absence was present in one case only and was associated with the presence of syrinx. Other patterns of abnormality were not a useful indicator of underlying cord abnormality.
BACKGROUND: Posterolateral thoracotomy can produce stretching of/or damage to the intercostal nerves and their branches. To assess intercostal nerve impairment after operation, we measured the superficial abdominal reflexes, which are mediated, at least in part, by the most inferior intercostal nerves. METHODS: Using electrophysiologic techniques, we made recordings from the left and right abdominal walls to study the responses evoked by mechanical stimulation of the skin after operation. In addition, we assessed postoperative pain intensity according to a numeric rating scale and recorded postoperative opioid dose. RESULTS: We found that the patients with complete disappearance of the superficial abdominal reflexes experienced more severe postoperative pain than those in whom the reflexes were maintained. Moreover, opioid treatment was less effective in the patients with no reflexes postoperatively. CONCLUSIONS: Our findings show a strict correlation between pain intensity after posterolateral thoracotomy and absence of abdominal reflexes. We suggest that the higher pain intensity together with the absence of reflexes may be due to intercostal nerve impairment, be it anatomic or functional, and thus to a larger neuropathic component of postoperative pain. This finding may be used as a predictor of patients with high analgesic requirements.
Cerebro-vascular complications of pheochromocytoma are now rare. The case reported here is a 47-year-old woman who presented with two cerebral hematomas and a pheochromocytoma. Abolition of a cutaneous abdominal reflex abolition can help the clinician to locate the adrenal tumor side.
We describe 12 children with idiopathic scoliosis who had a persistent absent superficial abdominal reflex (SAR) on routine neurological examination. MRI showed syringomyelia to be present in ten. The average age at detection of the scoliosis was 4.3 years and at diagnosis of syringomyelia 6.6 years. In all ten children the SAR was consistently absent on the same side as the convexity of the curve. In two it was the only abnormal neurological sign. An absent SAR in patients with scoliosis is an indication for investigation for underlying syringomyelia. In the children with syringomyelia, six had thoracic and four thoracolumbar curves. The clinical features differed in the two groups. Patients with thoracic curves were generally asymptomatic. Their neurological signs were subtle and none had any motor signs. By contrast, patients with thoracolumbar curves had symptoms and neurological signs. Abnormal gait was present in all four patients with thoracolumbar curves. In three this was due to considerable motor weakness. In eight children syringomyelia was associated with a Chiari-I malformation. In seven the syrinx was treated surgically by decompression of the foramen magnum.
The authors present a case of pheochromocytoma observed in a 49 year old man suffering from the cutaneous form of von Recklinghausen's disease. In this patient, they noted the constant absence of the inferior abdominal cutaneous reflex on the right side, contrasting with the briskness of the other abdominal cutaneous relexes. From this they concluded that the chromaffin tumor was very probably situated in the right adrenal region. This hypothesis was confirmed by retro-pneumoperitoneum, selective arteriography and finally surgical intervention. After having reviewed the essential medical data from the literature concerning the conditions associated with pheochromocytoma and especially phacomatosis, and having looked at the problem of hypertension related to neurofibromatosis, they make a critical study of the behaviour of the abdominal reflexes in case of pheochromocytoma and emphasize the part that it is possible to draw from this in view of its' topographic diagnosis. The present case is the fourth in which one of the authors has noted the abolition of the inferior abdominal reflex on the side corresponding to the site of the pheochromocytoma.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.