Pullicino P M, Jacobs L, McCall W D, Garvey M, Ostrow P T, Miller L L
Department of Neurology, State University of New York at Buffalo.
Ann Neurol. 1994 Feb;35(2):222-8. doi: 10.1002/ana.410350215.
In the classical corneomandibular reflex (CMR), corneal stimulation elicits a bilateral eyelid blink and a brisk anterolateral jaw movement. We here describe 14 patients with a spontaneous palpebromandibular (eyelid-jaw) synkinesia (SPMS) in whom jaw movements, similar to those in CMR, regularly accompanied spontaneous eye blinks without an external corneal stimulus. Eleven of the patients with SPMS also had CMRs on corneal stimulation. Four patients had clinical and imaging evidence of brainstem lesions above the mid-pons, 5 patients had autopsy or imaging evidence of both bilateral cerebral and upper brainstem lesions, and 5 patients had clinical or imaging evidence of bilateral cerebral dysfunction. Topical corneal anesthesia administered to patients who had both CMR and SPMS blocked the CMR but had no effect on the SPMS. In patients with both SPMS and CMR, measurements of latency from onset of orbicularis oculi electromyographic activity to onset of lateral pterygoid EMG activity, and mandibular kinesiography of jaw velocity and direction showed that the eyelid-jaw synkinesias of CMR and SPMS had similar characteristics. We conclude that SPMS is pathophysiologically the same as the eyelid-jaw synkinesia of CMR and both synkinesias originate centrally, probably in the pons. In CMR, the jaw movement is primarily related to the blink rather than the corneal stimulus, but corneal stimulation may be necessary to overcome a higher threshold for expression of the synkinesia than in patients with SPMS. Like CMR, SPMS emerges in patients with upper brainstem or bilateral cerebral lesions and SPMS may therefore be a useful localizing clinical sign.
在经典的角膜下颌反射（CMR）中，角膜刺激会引发双侧眼睑眨眼和快速的前外侧颌部运动。我们在此描述了14例患有自发性睑下颌（眼睑 - 颌部）联带运动（SPMS）的患者，在这些患者中，类似于CMR中的颌部运动，在没有外部角膜刺激的情况下，经常伴随自发性眨眼出现。11例SPMS患者在角膜刺激时也有CMR。4例患者有脑桥中部以上脑干病变的临床和影像学证据，5例患者有双侧大脑和上脑干病变的尸检或影像学证据，5例患者有双侧大脑功能障碍的临床或影像学证据。对同时患有CMR和SPMS的患者进行局部角膜麻醉可阻断CMR，但对SPMS没有影响。在同时患有SPMS和CMR的患者中，测量从眼轮匝肌肌电图活动开始到翼外肌肌电图活动开始的潜伏期，以及颌部速度和方向的下颌运动描记法显示，CMR和SPMS的眼睑 - 颌部联带运动具有相似的特征。我们得出结论，SPMS在病理生理学上与CMR的眼睑 - 颌部联带运动相同，并且这两种联带运动均起源于中枢，可能在脑桥。在CMR中，颌部运动主要与眨眼有关，而不是与角膜刺激有关，但角膜刺激可能是克服比SPMS患者更高的联带运动表达阈值所必需的。与CMR一样，SPMS出现在上脑干或双侧大脑病变的患者中，因此SPMS可能是一种有用的定位临床体征。
