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Introduction
Various movements may occur in coma; in cases without brainstem activity, the movements are presumed to be generated from the spinal cord. The superficial abdominal cutaneous reflex (SACR) is thought to be mediated by the spinoreticulocortical pathway [1]. We recently encountered a patient with brainstem areflexia who had markedly exaggerated abdominal movements triggered by a cutaneous stimulation.
Case Report
A 41-year-old man had sudden onset of headache, right hemiparesis, and became stuporous. A CT scan of the head showed a large left lobar hemorrhage with marked shift of midline. Twelve days after admission, both pupils became fixed at 5 mm. Corneal, oculocephalic (doll's head maneuver'), oculovestibular (ice water calories), and pharyngeal reflexes were absent. Apnea testing could not be performed due to a low blood pressure (80/50 mm Hg). The limbs were atonic, and deep tendon reflexes were absent. Stroking with a fingertip or with the blunt end of a reflex hammer over either side of the abdomen elicited a transient abdominal...