PatientÕs hand is held palm up with fingers slightly bent, and 3rd and 4th fingers are flexed at metacarpophalangeal joints until fingers touch palm. In normal patients, ipsilateral thumb adducts, flexes at metacarpophalangeal joint and extends at interphalangeal joint. This reflex is absent in corticospinal tract lesions, and sometimes bilaterally in normal patients, but it is exaggerated in brain tumors and meningitis.