The blink reflex in coma and after recovery from coma.

Comparative studies of the blink reflex in a series of head injuries through the stages of coma and recovery from coma in a series of miscellaneous hemispheral lesions, and in a normal series, reveals that, although the principal centre for the R1 component of the blink reflex seems to be localised in the upper pons, the seat of the R2 late component is in the reticular system. The reappearance of this late component of the blink reflex in our cases of coma although seeming to depend on the integrity of the mesencephalic formation, correlates with the recovery of the patient's alertness. On the other hand, habituation of this reflex depends on the integrity of global cognitive function, rather than on any localised centre. The roles of the cortex, selective attention, and emotional factors, are discussed. The recovery of the normal habituation of the blink reflex obtained by glabellar tapping was found to be a useful sign in the follow up of patients recovering from concussion and other lesions, such as subdural haematomas and brain tumours, with global mental impairment.