Babinski sign and related signs.pptx

this course describes the Babinski sign and other common related tests used to assess the pyramidal or corticospinal tract tract in other to clinically diagnose an upper motor neuron lesion.

1. Babinski sign and related signs Dr TSAMO NDOMO V. MD, MPH

2. Plan Introduction Physiology Indications Description Related signs Conclusion 2

3. Introduction The Babinski reflex (plantar reflex) was described by the neurologist Joseph Babinski in 1896. Since that time, it has been incorporated into the standard neurological examination. The Babinski reflex tests the integrity of the corticospinal tract (CST). The CST is a descending fiber tract that originates from the cerebral cortex through the brainstem and spinal cord. The CST is considered the upper motor neuron (UMN). 3

4. Introduction Stimulation of the lateral plantar aspect of the foot (S1 dermatome) normally leads to plantar flexion of the toes (due to stimulation of the S1 myotome). Babinski sign occurs when stimulation of the lateral plantar aspect of the foot leads to extension (dorsiflexion or upward movement) of the big toe (hallux) . Also, there may be fanning of the other toes. This suggests that there is been spread of the sensory input beyond the S1 myotome to L4 and L5. 4

5. Indications The Babinski reflex is done as part of the routine neurological exam and is utilized to determine the integrity of the CST. The presence of a Babinski sign suggests damage to the CST. Babinski reflex is especially important in the setting where there is suspicion of spinal cord injury or stroke , as it may be an early indicator of the presence of these emergency conditions. The only contraindication to performing the Babinski reflex is a lesion (such as an infection) in the affected area of the foot that precludes the effective performance of the reflex. 5

6. Description The patient should be relaxed and comfortable. It is best to advise the patient that the sensation may be slightly uncomfortable. To test for the Babinski sign, the instrument is run up the lateral plantar side of the foot from the heel to the toes and across the metatarsal pads to the base of the big toe. A negative response leads to plantar flexion of the toes A positive response leads to extension ( dorsiflexion or upward movement) of the big toe (hallux). 6

7. Description In infants with CST, which is not fully myelinated, the presence of a Babinski sign in the absence of other neurological deficits is considered normal up to 24 months of age. Babinski’s may be present when a patient is asleep. 7

8. Babinski Related signs Hoffman sign The Hoffman sign is an involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail of the middle finger down . The reflexive pathway causes the thumb to flex and adduct quickly. A positive Hoffman sign indicates an upper motor neuron lesion and corticospinal pathway dysfunction 8

9. Babinski Related signs Bekhterev-Jacobsohn Reflex The reflex is indicative of a lesion in the pyramidal tract of the upper limb. The Bekhterev-Jacobsohn reflex is best performed with the patient sitting or lying in the supine position with both arms extended and relaxed. The examiner can tap the radius with his or her hand or finger or can use a reflex hammer that is held in the opposite hand. A positive (or abnormal) reflex is abduction of the wrist and definite flexion of the fingers, specifically focused on the distal interphalangeal joints. A negative (or normal) reflex is when the fingers remain extended without any flexion or movement of the fingers or wrist. 9

10. Babinski Related signs Chaddock sign Just like the Babinski sign, the Chaddock sign test for the integrity of the cortico spinal track. Chaddock reflex is elicited by stimulating the dorsolateral aspect of the foot from the posterior portion of the skin just beneath the external malleolus anteriorly and along the external edge of the foot. Both the Chaddock and Babinski reflex lead to dorsiflexion of the big toe and fanning of the other toes when there is a dysfunction of the CST. 10

11. Babinski Related signs Gordon Reflex Gordon reflex, also called the paradoxical flexor reflex , is a clinical sign utilized to detect upper motor neuron lesions. Evaluation of this reflex is simple and rapid and does not require the use of any equipment. It is particularly beneficial in the diagnosis of pyramidal tract lesions. IT’s extremely useful in cases where the Babinski reflex cannot be completed due to the poor cooperation of the patient or in an equivocal response. 11

12. Babinski Related signs The Gordon reflex is best completed with the patient lying in the supine position with legs extended. The patient needs to be relaxed without the contraction of the leg muscles. The practitioner places his or her hand on the calf muscle underneath the patient’s leg, then lifts and supports the leg with the other hand at the ankle area. The practitioner then tightly squeezes the calf muscle while monitoring the ipsilateral toes. The Gordon reflex is positive (or abnormal) if there is an extensor plantar reflex or extension of the big toe with fanning of the other toes . A negative (or normal) Gordon reflex is no response in the toes with squeezing of the ipsilateral calf muscle. 12

13. Babinski Related signs Oppenheim reflex Like the previous tests, it help to evaluate the corticospinal tract (pyramidal tract) It’s elicited by stroking along the medial side of the tibia . A positive response is the dorsiflexion of the big toe , sometimes accompanied by fanning of the other toes. the normal response would be no movement of the big toe. 13

14. Babinski Related signs Moniz sign Moniz sign is a clinical sign in which forceful passive plantar flexion of the ankle elicits an extensor plantar reflex . It is found in patients with pyramidal tract lesions, and is one of a number of Babinski-like responses. 14

15. In Fine Testing for the Babinski sign is a way of evaluation of the corticospinal or pyramidal tract, therefore defining an uppermotor neuron lesion . They’re are many other signs both on the upper and lower limb , which like the Babinski sign can help in the evaluation of upper motor neuron lesion . Understing these signs enable the clinician to have a clue of the location of a lesion , especially in emergencies situations. In case of contrindication of a sign , another one can be used interchangeably . 15