Frontal release sign

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Frontal release sign
Differential diagnosis Dementia

Frontal release signs are primitive reflexes traditionally held to be a sign of disorders that affect the frontal lobes. The appearance of such signs reflects the area of brain dysfunction rather than a specific disorder which may be diffuse, such as a dementia, or localised, such as a tumor. [1]

One reflex thought to have good localizing value is the palmar grasp reflex which usually signifies damage to the frontal lobe of the opposite side. [1] The glabellar reflex or "glabellar tap" is present in individuals with extrapyramidal disorders such as Parkinson's disease. [2]

These reflexes are believed to be "hard-wired" before birth, and are therefore able to be elicited in the newborn. As the brain matures, certain areas (usually within the frontal lobes) exert an inhibitory effect, thus causing the reflex to disappear. When disease processes disrupt these inhibitory pathways, the reflex is "released" from inhibition and can be elicited once again, hence the term "frontal release sign". [3]

Some frontal release signs and their role in infancy:[ citation needed ]

Related Research Articles

Alien hand syndrome (AHS) or Dr. Strangelove syndrome is a category of conditions in which a person experiences their limbs acting seemingly on their own, without conscious control over the actions. There are a variety of clinical conditions that fall under this category, which most commonly affects the left hand. There are many similar terms for the various forms of the condition, but they are often used inappropriately. The affected person may sometimes reach for objects and manipulate them without wanting to do so, even to the point of having to use the controllable hand to restrain the alien hand. Under normal circumstances however, given that intent and action can be assumed to be deeply mutually entangled, the occurrence of alien hand syndrome can be usefully conceptualized as a phenomenon reflecting a functional "disentanglement" between thought and action.

In biology, a reflex, or reflex action, is an involuntary, unplanned sequence or action and nearly instantaneous movement in response to a stimulus. A reflex is made possible by neural pathways called reflex arcs which can act on an impulse before that impulse reaches the brain. The reflex is then an automatic response to a stimulus that does not receive or need conscious thought.

Plantar reflex Reflex elicited when the sole of the foot is stimulated with a blunt instrument

The plantar reflex is a reflex elicited when the sole of the foot is stimulated with a blunt instrument. The reflex can take one of two forms. In healthy adults, the plantar reflex causes a downward response of the hallux (flexion). An upward response (extension) of the hallux is known as the Babinski response or Babinski sign, named after the neurologist Joseph Babinski. The presence of the Babinski sign can identify disease of the spinal cord and brain in adults, and also exists as a primitive reflex in infants.

Frontotemporal dementia Types of dementia involving the frontal or temporal lobes

Frontotemporal dementia (FTD), or frontotemporal degeneration disease, or frontotemporal neurocognitive disorder, encompasses several types of dementia involving the progressive degeneration of frontal and temporal lobes. FTDs broadly present as behavioral or language disorders with gradual onsets. The three main subtypes or variant syndromes are a behavioral variant (bvFTD) previously known as Pick's disease, and two variants of primary progressive aphasia – semantic variant (svPPA), and nonfluent variant (nfvPPA). Two rare distinct subtypes of FTD are neuronal intermediate filament inclusion disease (NIFID), and basophilic inclusion body disease. Other related disorders include corticobasal syndrome and FTD with amyotrophic lateral sclerosis (ALS) FTD-ALS also called FTD-MND.

Moro reflex Neurologic importance

The Moro reflex is an infantile reflex that develops between 28 and 32 weeks of gestation and disappears at 3–6 months of age. It is a response to a sudden loss of support and involves three distinct components:

  1. spreading out the arms (abduction)
  2. pulling the arms in (adduction)
  3. crying (usually)
Progressive supranuclear palsy Medical condition

Progressive supranuclear palsy (PSP) is a late-onset degenerative disease involving the gradual deterioration and death of specific volumes of the brain. The condition leads to symptoms including loss of balance, slowing of movement, difficulty moving the eyes, and cognitive impairment. PSP may be mistaken for other neurodegenerative diseases such as Parkinson's, frontotemporal dementia and Alzheimer's. The cause of the condition is uncertain, but involves accumulation of tau protein within the brain. Medications such as levodopa and amantadine may be useful in some cases.

Anterior cerebral artery

The anterior cerebral artery (ACA) is one of a pair of cerebral arteries that supplies oxygenated blood to most midline portions of the frontal lobes and superior medial parietal lobes of the brain. The two anterior cerebral arteries arise from the internal carotid artery and are part of the circle of Willis. The left and right anterior cerebral arteries are connected by the anterior communicating artery.

Frontal lobe disorder Brain disorder

Frontal lobe disorder, also frontal lobe syndrome, is an impairment of the frontal lobe that occurs due to disease or frontal lobe injury. The frontal lobe of the brain plays a key role in executive functions such as motivation, planning, social behaviour, and speech production. Frontal lobe syndrome can be caused by a range of conditions including head trauma, tumours, neurodegenerative diseases, Neurodevelopmental disorders, neurosurgery and cerebrovascular disease. Frontal lobe impairment can be detected by recognition of typical signs and symptoms, use of simple screening tests, and specialist neurological testing.

The glabellar reflex, also known as the "glabellar tap sign", is a primitive reflex elicited by repetitive tapping of the glabella — the smooth part of the forehead above the nose and between the eyebrows. Subjects respond to the first several taps by blinking; if tapping were to then be made to persist, in cognitively intact individuals this would lead to habituation and consequent suppression of blinking. If instead the blinking were to persist along with the tapping, this is known as Myerson's sign, and is abnormal and a sign of frontal release; it is often seen in people who have Parkinson's disease.

Utilization behavior (UB) is a type of neurobehavioral phenomena that involves someone grabbing objects in view and starting the 'appropriate' behavior associated with it at an 'inappropriate' time. Utilization behavior people have difficulty resisting the impulse to operate or manipulate objects which are in their visual field and within reach. Characteristics of UB include unintentional, unconscious actions triggered by the immediate environment. The unpreventable excessive behavior has been linked to lesions in the frontal lobe. UB has also been referred to as "bilateral magnetic apraxia" and "hypermetamorphosis".

The Snout reflex or a "Pout" is a pouting or pursing of the lips that is elicited by light tapping of the closed lips near the midline. The contraction of the muscles causes the mouth to resemble a snout.

The triceps reflex, a deep tendon reflex, is a reflex as it elicits involuntary contraction of the triceps brachii muscle. It is initiated by the Cervical spinal nerve 7 nerve root. The reflex is tested as part of the neurological examination to assess the sensory and motor pathways within the C7 and C8 spinal nerves.

Primitive reflexes are reflex actions originating in the central nervous system that are exhibited by normal infants, but not neurologically intact adults, in response to particular stimuli. These reflexes are suppressed by the development of the frontal lobes as a child transitions normally into child development. These primitive reflexes are also called infantile, infant or newborn reflexes.

Focal neurologic signs also known as focal neurological deficits or focal CNS signs are impairments of nerve, spinal cord, or brain function that affects a specific region of the body, e.g. weakness in the left arm, the right leg, paresis, or plegia.

Hoffmann's reflex is a neurological examination finding elicited by a reflex test which can help verify the presence or absence of issues arising from the corticospinal tract. It is named after neurologist Johann Hoffmann. Usually considered a pathological reflex in a clinical setting, the Hoffmann's reflex has also been used as a measure of spinal reflex processing (adaptation) in response to exercise training.

Paratonia

Paratonia is the inability to relax muscles during muscle tone assessment. There are two types of paratonia: oppositional and facilitatory. Oppositional paratonia ("gegenhalten") occurs when subjects involuntarily resist to passive movements, while facilitatory paratonia ("mitgehen") occurs when subjects involuntary assist passive movements.

The palmomental reflex (PMR) is a primitive reflex consisting of a twitch of the chin muscle elicited by stroking a specific part of the palm. It is present in infancy and disappears as the brain matures during childhood but may reappear due to processes that disrupt the normal cortical inhibitory pathways. Therefore, it is an example of a frontal release sign.

Palmar grasp reflex Primitive and involuntary reflex

Palmar grasp reflex is a primitive and involuntary reflex found in infants of humans, most primates, and domesticated felines. When an object, such as an adult finger, is placed in an infant's palm, the infant's fingers reflexively grasp the object. Kittens and adult cats will grasp a finger placed in the palm of the paw.[1b] Placement of the object triggers a spinal reflex, resulting from stimulation of tendons in the palm, that gets transmitted through motor neurons in the median and ulnar sensory nerves. The reverse motion can be induced by stroking the back or side of the hand. A fetus exhibits the reflex in utero by 28 weeks into gestation, and persists until development of rudimentary fine motor skills between two to six months of age.

Signs and symptoms of Parkinson's disease are varied. Parkinson's disease affects movement, producing motor symptoms. Non-motor symptoms, which include dysautonomia, cognitive and neurobehavioral problems, and sensory and sleep difficulties, are also common. When other diseases mimic Parkinson's disease, they are categorized as parkinsonism.

References

  1. 1 2 Walker, H. Kenneth (1990-01-01). Walker, H. Kenneth; Hall, W. Dallas; Hurst, J. Willis (eds.). Clinical Methods: The History, Physical, and Laboratory Examinations (3rd ed.). Boston: Butterworths. ISBN   978-0409900774. PMID   21250236.
  2. Vreeling, Fred W; Verhey, Frans R J; Houx, Peter J; Jolles, Jellemer (1993). "Primitive reflexes in Parkinson's disease". Journal of Neurology, Neurosurgery, and Psychiatry. 56 (12): 1323–1326. doi:10.1136/jnnp.56.12.1323. PMC   1015384 . PMID   8270937.
  3. Salloway, Stephen P. (2011-01-01). "Glabellar Reflex". In Kreutzer, Jeffrey S.; DeLuca, John; Caplan, Bruce (eds.). Encyclopedia of Clinical Neuropsychology. Springer New York. p. 1149. doi:10.1007/978-0-387-79948-3_1897. ISBN   9780387799476.