Images in Neurology
June 2013

Corneomandibular Reflex (Wartenberg Reflex) in ComaA Rarely Elicited Sign

Author Affiliations

Author Affiliations: Departments of Neurology (Drs Heliopoulos, Vadikolias, Tsivgoulis, Tsakaldimi, and Piperidou) and Cardiothoracic Surgery (Dr Mikroulis), Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.

JAMA Neurol. 2013;70(6):794. doi:10.1001/jamaneurol.2013.1944

A 52-year-old man underwent emergent surgery for a dissecting aneurysm of aorta type A (dissection of ascending, arch, and descending thoracic aorta) and remained intubated. Neurological examination revealed dilatation of the left pupil (6 mm) with no light response. Oculocephalic and oculovestibular reflexes were abolished. There was bilateral Babinski sign and bilateral decerebrate posture after pain stimuli. Stimulation for testing the corneal reflex elicited a normal direct response, an absent consensual response, and a horizontal movement of the mandible to the contralateral side (corneomandibular reflex [Wartenberg reflex]) (

) on both sides. Neuroimaging showed a massive cerebral infarct (Figure). The patient died 7 days after the initial neurological consultation.

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