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August 18, 2020; 95 (7) Video NeuroImages

Absent triceps reflex with forearm flexion

A new form of inverted reflex

Joumana Freiha, Madiha M. Shatila, Kamal Tarabine, Naji Riachi, Raghid Kikano, Rechdi Ahdab
First published July 8, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010182
Joumana Freiha
From the Departments of Neurology (J.F., M.M.S., N.R., R.A.) and Radiology (K.T., R.K.), Lebanese American University, Beirut, Lebanon.
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Madiha M. Shatila
From the Departments of Neurology (J.F., M.M.S., N.R., R.A.) and Radiology (K.T., R.K.), Lebanese American University, Beirut, Lebanon.
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Kamal Tarabine
From the Departments of Neurology (J.F., M.M.S., N.R., R.A.) and Radiology (K.T., R.K.), Lebanese American University, Beirut, Lebanon.
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Naji Riachi
From the Departments of Neurology (J.F., M.M.S., N.R., R.A.) and Radiology (K.T., R.K.), Lebanese American University, Beirut, Lebanon.
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Raghid Kikano
From the Departments of Neurology (J.F., M.M.S., N.R., R.A.) and Radiology (K.T., R.K.), Lebanese American University, Beirut, Lebanon.
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Rechdi Ahdab
From the Departments of Neurology (J.F., M.M.S., N.R., R.A.) and Radiology (K.T., R.K.), Lebanese American University, Beirut, Lebanon.
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Citation
Absent triceps reflex with forearm flexion
A new form of inverted reflex
Joumana Freiha, Madiha M. Shatila, Kamal Tarabine, Naji Riachi, Raghid Kikano, Rechdi Ahdab
Neurology Aug 2020, 95 (7) 314-315; DOI: 10.1212/WNL.0000000000010182

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A 65-year-old man presented with neck pain and right arm weakness and tingling. Examination displayed grade 3/5 weakness of the right triceps and a C7 dermatome sensory loss. Triceps reflex testing elicited flexion rather than extension of the forearm (video 1). MRI demonstrated a large C6-C7 disc indenting on the thecal sac anteriorly and compressing the C7 root on the right side (figure). Spreading of the reflex to an adjacent myotome is a sign of cord injury with pathologic sensitization of the intrinsic cord circuitry. Inverted reflexes were also described in the knee1 and brachioradialis.2

Video 1

Inverted triceps reflex. Triceps reflex testing elicited flexion rather than extension of the forearm.Download Supplementary Video 1 via http://dx.doi.org/10.1212/010182_Video_1

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Figure Cervical spine MRI

Sagittal (A) and axial (B) T2-weighted imaging of the cervical spine demonstrating protruded discs at C4-C5 and C6-C7 narrowing the spinal canal (sagittal) and right foraminal disc protrusion impinging the C7 nerve exit (axial).

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No targeted funding reported.

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The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.

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  • © 2020 American Academy of Neurology

References

  1. 1.↵
    1. Boyle RS,
    2. Shakir RA,
    3. Weir AI, et al
    . Inverted knee jerk: a neglected localising sign in spinal cord disease. J Neurol Neurosurg Psychiatry 1979;42:1005–1007.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Estanol BV,
    2. Marin OS
    . Mechanism of the inverted supinator reflex: a clinical and neurophysiological study. J Neurol Neurosurg Psychiatry 1976;39:905–908.
    OpenUrlAbstract/FREE Full Text

Disputes & Debates: Rapid online correspondence

  • Reader response: Absent triceps reflex with forearm flexion: A new form of inverted reflex
    • William W. Campbell, Neurologist, None
    Submitted October 29, 2020
  • Reader response: Absent triceps reflex with forearm flexion: A new form of inverted reflex
    • Christopher J. Boes, Neurologist, Mayo Clinic (Rochester, MN)
    Submitted August 17, 2020
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