ENS 2009: Palmomental Reflex May Signal Silent Stroke

Allison Gandey

June 24, 2009

June 24, 2009 (Milan, Italy) — Patients with first ischemic stroke and vascular risk factors are more likely to have palmomental reflex and multiple silent ischemic lesions compared with a healthy control population, reported researchers.

Presenting here at the 19th Meeting of the European Neurological Society, investigators proposed a new purpose for the old-school neurological exam.

Palmomental reflex may be useful as part of a multifaceted screening approach, suggested the researchers, led by Radu Tanasescu, MD, from the University of Medicine in Bucharest, Romania.

Patients with vascular risk factors and no history of stroke who show evidence of the reflex may prove to be good candidates for cerebral imaging to prevent stroke, they speculated, but they also emphasized that the work is preliminary and will need to be confirmed.

Asked by Medscape Neurology to comment on the study, Cristina Vilotti, MD, from the University of Trieste, in Italy, said, "This is an interesting theory that could have important implications." But she added, "I'm not sure to what extent this has been backed by other studies." Dr. Vilotti said she looks forward to seeing new data as they become available.

New Purpose for Old Exam

Palmomental reflex is part of classical neurological examination, the researchers noted, "but it has lost practical real usefulness because of its low specificity for a particular lesional location."

In the current prospective study, the research team combined 2 independent studies of the same patient population. One study focused on the prevalence of palmomental reflex and the other examined the number of silent infarcts determined by computed tomography (CT).

Investigators studied 564 patients with vascular risk factors and first stroke and compared them with healthy controls matched for age and sex. They found that more than half of patients with first stroke had silent ischemic infarcts on CT (53%).

Scans were read by 2 independent raters, with an average interrater variability of 7%. As expected, the researchers showed there was a significant correlation between silent strokes, high blood pressure, and smoking.

Two blinded examining physicians tested for palmomental reflex. They found it in 51.4% of first stroke patients and 9.2% of healthy controls (P < .05).

They observed silent infarcts in 71% of stroke patients with palmomental reflex and 36% of those without.

"There was a significant correlation between palmomental reflex and the presence of more than 2 silent ischemic lesions on CT scan," Dr. Tanasescu reported. "There was not a unique pattern of distribution of silent infarcts in those with palmomental reflex, but all patients with subcortical ischemic lesions had the reflex."

The researchers have disclosed no relevant financial relationships.

19th Meeting of the European Neurological Society: Abstract P382. Presented June 23, 2009.