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Corneomandibular reflex in a patient with pontine hemorrhage without impaired consciousness


A 40-year-old man was admitted because of sudden loss of consciousness. CT scan showed a bilateral pontine hemorrhage, predominantly right (figure). Neurologic examination 19 days after onset showed ophthalmoplegia, anarthria, and tetraparesis. A prominent unilateral left corneomandibular reflex was observed and the patient was conscious and responsive to the examiner (video 1). This reflex consists of contralateral jaw deviation produced by corneal stimulation and has mostly been described in patients in coma.1 It helps to distinguish structural from metabolic processes in comatose patients. We emphasize that this sign can also be elicited in alert patients with destructive brainstem damage.

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