Background: The purpose of this study was to determine the diagnostic value of the palmomental reflex in order to identify frontal lesions in neurological outpatients.
Methods: Two hundred twenty-six neurological patients with suspected intracranial lesion with an indication for magnetic resonance imaging (MRI) were included. All patients underwent the same MRI protocol. The reflex was elicited by trained and standardized nurses, and was evaluated by two neurologists. The evaluation was blind and independent. The test's accuracy was calculated. The Kappa coefficient was used to calculate the interobserver and intra-observer reliability.
Results: The interobserver reliability between neurologists was 0.53 with 93% of agreement (p<0.001). The diagnostic accuracy measures were as follow: sensitivity of 19%, specificity of 93%, positive predictive value of 30%, negative predictive value of 88%, positive likelihood ratio of 2.7 and negative likelihood ratio of 0.87. The area under the curve was 0.56.
Conclusion: The palmomental reflex is associated with frontal structural lesions but the sensitivity is low, indicating a high percentage of frontal lesions with a negative reflex. When the test is used on its own, it is insufficient to detect frontal damage.
Keywords: Diagnostic test; Marinesco–Radovici; Neurological signs; Physical examination; Primitive reflex; Semiology.
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