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May 26, 2015: Nasociliary reflex

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May 26, 2015

Nasociliary reflex

The sternutatory reflex otherwise known as the nasociliary reflex is an examination aid that can aid in providing objective evidence of trigeminal nerve dysfunction in patients reporting facial numbness. It is performed by introducing noxious stimuli into the ipsilateral nostril via the end of a q-tip and looking for grimacing. Sensation of anterior nasal mucosa is innervated by the nasociliary nerve, a branch of V1 nerve as it exits the superior orbital fissure. If a patient has numbness of the V1 distribution of the face, he or she would be not be wavered by noxious stimuli to the ipsilateral nostril. This test should also be used in conjunction with other aids such as corneal reflex, strength of lateral jaw movement and jaw protrusion.

For patients with strokes requiring temporary feeding tube placement, one can introduce the nasogastric tube into the nostril with the impaired sternutatory reflex to minimize patient discomfort.

References

  1. Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurology 2008; 7: 1091-1098.
  2. Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedmand D. Extreme Delta Brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology 2012; 79: 1094-1100.

Submitted by Joe Zachariah, M.D.; Neurology resident, Department of Neurology, Case Western Reserve University, Cleveland, Ohio

Disclosures: Dr. Zachariah reports no disclosures.

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