Unedited pathological recurrent association of palmomental and rooting archaic reflexes in a young woman with severe traumatic brain lesions – case presentation and physiopathological considerations

Abstract

Introduction. Archaic reflexes are present in infancy, disappear as the brain matures, but reappear in pathological conditions. Case report. A 29-years-old woman has suffered a severe traumatic brain injury. She was admitted to neurorehabilitation 6 months after neurosurgical interventions (ventriculoperitoneal shunt for traumatic hydrocephalus, emerged after decompressive craniectomy). Neurological examination revealed a minimal conscious state, spastic tetraparesis, trismus, central facial palsy, nystagmus, bilateral palm-chin reflex, and a “mitigated” variant of the rooting reflex. The left corneal, snout and glabellar reflexes were absent. Osteotendinous reflexes were brisk, Babinski sign was bilaterally present, palmar and plantar grasp reflexes were absent. The trismus has persisted and chewing remained severely disabled after botulinum toxin injected in the left temporalis muscle and bilaterally in the masseter. The patient was fed by percutaneous endoscopic gastrostomy tube. Neurologic evolution remained stationary after two months of rehabilitative nursing. Discussion. The palmomental reflex described by Marinescu and Radovici, is elicited by scratching the thenar eminence of the palm, and consists of an ipsilateral twitch of the mentalis muscle. Baby rooting for milk is a primitive trigemino-facial reflex found in newborn infants. The lower lip is lowered, and the tongue is moved in the direction where the cheek near the corner of the mouth is brushed. The lockjaw has “mitigated” the classical pattern of clinical response. Repeated stimulation causes a unilateral mentalis muscle response, similar to the palm-chin reflex. The severe traumatic brain lesions have induced pathological reappearance of the palmomental and rooting archaic reflexes, in a unique, unedited pathological association. Key words: palmomental reflex (Marinescu Radovici reflex); rooting reflex; archaic reflexes; botulinum toxin; traumatic brain injury; minimal conscious state,