syndrome and small cell lung carcinoma . patient with paraneoplastic cerebellar Association of antineural autoantibodies in a

nied with no pupillary change, it was most probably realised through the activity of the oculomotor nerve although we did not perform EMG recording of the muscles. The afferent limb of this reflex is probably attributable to proprioceptive impulses rising in the deep tissues of the arm such as muscles, ligaments, tendons, and joints participating in flexion of the arm. It is unlikely that pain receptors played a part, because the patients did not open their eyes to painful stimuli. The "arm EOR" was accompanied by extension of the head and contralateral limbs suggesting a decerebrate response. Decerebrate response usually occurs in brainstem lesions with at least partial and bilateral midbrain pontine lesions, but occasionally in severe diffuse bilateral hemispheric damage due to posthypoxic encephalopathy.4 This response is interpreted as a release phenomenon of the brainstem activity from higher extrapyramidal control. It includes not only extension of the limbs and body, but also some pathological reflexes of the head such as clenching of the jaw ("a bulldog" reflex), which was seen in our patient 1, or, on the other hand, jaw opening.56 These reflexes must require activity of the appropriate cranial nucleus and its efferent pathways. The "arm EOR" may be regarded as a variation of these decerebrate responses involving the cranial nerves. It at least suggests preservation of the central caudal nucleus, which is thought to be responsible for elevation of the eyelids. We report with confidence that there exists an EOR elicited by flexion of the arm. It may be a manifestation of decerebrate response, especially in diffuse bilateral hemispheric damage after acute hypoxicischaemic encephalopathy. This phenomenon may be mediated through the proprioceptive system, although it has been considered that the pain system has the most important role in occurrence of both decerebrate response and wakefulness.' SHINGO OHKAWA TAKASHI YOSHIDA YUKIO OHSUMI MASAYASU TABUCHI Neurology Service, Hyogo Brain and Heart Center at Himeji, Himeji, Japan ATSUSHI YAMADORI Division of Disability Science, Tohoku University Graduate School ofMedicine, Sendai, Japan