2010 Alphabet Update. In 2010, a number of changes occurred to the Spanish alphabet, according to the Real Academia EspaÃ±ola. Prior to 2010, the Spanish alphabet had 29 letters. The Real Academia EspaÃ±ola had included ch and ll, as officially recognized letters. They do have distinct pronunciations, much like ch does in English.
The trigeminocardiac reflex (TCR) is a well-established brain stem reflex. Since it was first described by Schaller in 1999, the TCR has gone from being considered an episodic occurrence to becoming known as one of the most important phenomena ever seen in a number of different neurosurgical procedures, especially skull-base surgery. 1.; 2.; 3.; 4.
In comatose or severely lethargic patients, the vestibulo-ocular reflex can be used to test whether brainstem eye movement pathways are intact. The oculocephalic reflex, a form of the vestibulo-ocular reflex, is tested by holding the eyes open and rotating the head from side to side or up and down.