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ULY CLINIC
ULY CLINIC
23 Septemba 2025, 12:33:51
Erben’s reflex
Erben’s reflex is a cardiovascular reflex characterized by slowing of the pulse when the head and trunk are forcibly flexed forward.
A positive reflex indicates increased vagal excitability or heightened parasympathetic activity.
It is considered a clinical sign of autonomic nervous system responsiveness rather than a primary disease itself.
Pathophysiology
The reflex is mediated by vagal stimulation: flexion of the head and trunk stretches structures in the neck and thorax, activating afferent vagal fibers.
This leads to increased parasympathetic output to the heart via the vagus nerve, resulting in bradycardia or pulse slowing.
May occur in conditions where vagal tone is elevated, such as:
Autonomic nervous system hypersensitivity
Certain cardiac conditions
Neurological disorders affecting brainstem centers
Examination Technique
Patient Positioning
Have the patient stand or sit upright.
Procedure
Instruct the patient to bend the head and trunk forward slowly.
Observe or palpate the radial or carotid pulse before and during the maneuver.
Assessment
A marked slowing of the pulse with forward flexion indicates a positive Erben’s reflex.
Record the degree of bradycardia and note any associated symptoms (dizziness, syncope).
Clinical Features
Feature | Description |
Pulse change | Slowing of the heart rate upon flexion of head and trunk |
Symptom association | May be accompanied by lightheadedness or syncope if vagal response is strong |
Autonomic involvement | Reflects heightened parasympathetic (vagal) activity |
Differential Diagnosis
Cause / Condition | Key Features | Notes |
Normal vagal reflex | Mild slowing without symptoms | Usually physiological |
Vagal hyperexcitability | Pronounced bradycardia, dizziness, syncope | May occur in young healthy adults or athletes |
Neurological disorders | Brainstem or medullary dysfunction affecting autonomic centers | Evaluate with neuroimaging if suspected |
Cardiac conduction abnormalities | Sinus node dysfunction, AV block | May mimic exaggerated vagal response |
Orthostatic intolerance | Bradycardia or hypotension with position changes | Usually accompanied by postural symptoms |
Pediatric considerations
Rarely assessed routinely in children.
Excessive vagal responses may manifest as syncope during sudden postural changes.
Geriatric considerations
Older adults may have blunted or exaggerated reflexes due to autonomic nervous system changes.
Monitor carefully in patients with cardiac conduction disease.
Limitations
Reflex is not diagnostic on its own.
Must interpret in context of clinical history, symptoms, and other cardiovascular signs.
Patient counseling
Explain that the test assesses autonomic (vagal) heart responses.
Reassure that a mild slowing is usually harmless.
Advise patients to avoid sudden bending or straining if prone to dizziness or fainting.
Conclusion
Erben’s reflex is a vagal-mediated slowing of the pulse during forward flexion of the head and trunk, reflecting parasympathetic excitability. While often benign, exaggerated responses may indicate autonomic hyperreactivity or underlying cardiac or neurological conditions. Accurate assessment helps guide further evaluation and management.
References
Erben H. Über einen neuen Reflex zur Beurteilung der vagalen Herzinnervation. Wien Klin Wochenschr. 1914;27:341–343.
Kandel ER, Schwartz JH, Jessell TM. Principles of Neural Science. 5th ed. New York: McGraw-Hill; 2013.
Ropper AH, Samuels MA, Klein JP. Adams and Victor’s Principles of Neurology. 11th ed. New York: McGraw-Hill; 2021.
Abuelo JG. Vagal Reflexes and Their Clinical Significance. J Clin Neurophysiol. 2006;23(6):567–574.