Babinsky Sign

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Permalink Reply by Jody Jakob on May 18, 2008 at 7:19pm

The lateral side of the sole of the foot is rubbed with a blunt implement so as not to cause pain, discomfort or injury to the skin; the instrument is run from the heel along a curve to the metatarsal pads. There are three responses possible:

Flexor: the toes curve inward and the foot everts; this is the response seen in healthy adults.
Indifferent: there is no response.
Extensor: the hallux dorsiflexes, and the other toes fan out - the Babinski's sign indicating damage to the central nervous system.
As the lesion responsible for the sign expands so does the area from which the afferent Babinski response may be elicited. The Babinski response is also normal while asleep and after a long period of walking.


The Babinski’s sign can indicate upper motorneuron damage to the spinal cord in the thoracic or lumbar region, or brain disease constituting damage to the corticospinal tract. Occasionally, a pathological plantar reflex is the first (and only) indication of a serious disease process, and a clearly abnormal plantar reflex often prompts detailed neurological investigations, including CT scanning of the brain or MRI of the spine, as well as lumbar puncture for the study of cerebrospinal fluid.
What would be interesting for us is to know why she has come to see you and what are her other symptoms and signs??

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Permalink Reply by Bruno Moreira Campos on May 19, 2008 at 1:01am

I did the test properly 3 times on each foot.
She went to see a doctor and did an MRI to the brain because of the Multiple Sclerosis diagnosed on her mother a few months ago.
She came to see me with right sacroiliac and lumbar pain. Rarely irradiates to the external side of her leg and foot. Right knee pain. Normal tonus and strength. The only neurological test positive was the babinsky but because she was getting the result of the MRI this week i didn't discussed that in particular. Now the doctor said everything is normal and she's coming to see me next week.

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Permalink Reply by Jody Jakob on May 19, 2008 at 6:54am

Keep us informed as to what happens. By the way I do not think that there is any increased incidence for MS in family members but I could be wrong about this. Anybody else know for sure??

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Permalink Reply by Clement Rhein on June 7, 2008 at 12:09pm

Its does seem that there is a genetic factor:
"MS likely occurs as a result of some combination of both environmental and genetic factors." Wikipedia.

I think its similar to RA, SLE, CV probs, diabetes...
Poison in foods (or other factors) - impairs/alters physiology - physiology gets rewired/adapts to this change, that info goes thro the genes (S—>F—>S) - next kids are predisposed to that same disease.

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Permalink Reply by expatient on June 28, 2008 at 4:35pm

>She came to see me with right sacroiliac and lumbar pain. Rarely irradiates to the external side of her leg and foot. Right knee pain.

Those are the most common symptoms for ilium upslip. It creates a torsion to pelvis causing right side low back pain and right side sij pain and right limb knee & groin problems. Those symptoms indicate left ilium upslip causing the symptoms to right side.

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Permalink Reply by Clement Rhein on June 29, 2008 at 8:30am

What is ilium upslip exactly?

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Permalink Reply by expatient on July 3, 2008 at 8:31am

There are many names for it: Subluxation of sacroiliac joint, innominate or ilium uplift/upslip, SIJ out of place, iliosacral dysfunction, malaligned pelvis, etc. Some, like osteopathics, have given it also many subgroups like anteriorly/posteriorly rotated ilium, etc.

Most call it just SIJ dysfunction but at the same time they don't seem to understand much about it. It is common disorder with animals too (horses, cows, dogs, etc.).

This disorder is mentioned in Foundations for Osteopathic Medicine, pelvis and sacrum, page 762. (kurt p. heinking & robert e. kappler)

There is also something about it in P. E. Greenman's Principles of Manual Medicine.

Everybody explanes it differently, so it is very hard to understand what it really is because of it's countless amount of symptoms and effects on spine and body.

Some experts think it is very common disorder and causes many problems not only to spine but also everything between feet and neck. I agree with them. I have experienced many of them myself.

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Permalink Reply by Clement Rhein on July 3, 2008 at 2:51pm

A okay, cheers matey. I call it SI dysfunction myself, perhaps I don't understand much about it then! :-)

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Permalink Reply by Paul Manley on June 28, 2008 at 10:01pm

Babinski positive?

In my experience the Babinski test is a good one.
It is reliable as long as you know what a positive response actually looks like.

It will appear in spastic paraplegics ( for example ) as a 'clonic' reaction, often accompanied by cramp-like pain along the anterior peroneal muscle group. The big toe raises up like a hitch-hikers thumb and the other toes lift and flair. This is an abnormal reaction to a 'scrape' running from heel, along the lateral side of the sole, and across the metatarsal arch fat pad, ending at the base of the big toe.

Sometimes you can see a partial response but this possibility can be eradicated as a factor on repetition of the test, two or three times.

The patient often must get 'used' to the rather uncomfortable feel of this 'scraping' of the sole.The area is often very ticklish and can yield peculiar results when tested.

No neurological positive should be taken in isolation, so don't neglect the other signs of upper motor neurone disorders ( look 'em up ).

If you find another reflex sign such as the abdominal reflex and the glabella test, then tot up the score. Look for signs of hyper-reflexia in the upper and lower limbs. The clonic, 'ratchet like' reactions to passive flexing of the knee joint adds to the diagnosis if found positive. Mild visible swallowing difficulty is often a 'closure' sign for me.

This says to me that the patient may be suffering from a cerebellar lesion. This can be confirmed by the cerebellar test procedure of oculomotor functions and limb co-ordination tests.

It is most often easiest to reveal cerebellar dysfunction by using the test for disdiadokinesis. The rapid pronation - supination of the foreaearm involved in this test seems to be one of the first things to go wrong in a lot of cases of cerebellar dysfunction.

The final step is localisation of the lesion(s) if possible.

Paul

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Permalink Reply by Nancy on June 29, 2008 at 1:42pm

I don't think any test ever can be 100% reliable and should be interpreted along with others (see details in Paul's note).
A note on MS, I have a patient who has at sometimes shown transient signs clinical which could suggest MS. One sign persisted for several months. She has been investigated for MS a number of times. The diagnosis is difficult even for neurologists because some of the MRI signs can be classified as "normal" if found in small numbers and the lesions are considered to be pathologically non-specific (Traboulsee & Li, 2006). Recommended diagnostic criteria now include clinical signs as well as MRI findings (McDonald et al, 2006).

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Permalink Reply by Jody Jakob on June 29, 2008 at 2:06pm

MS can be tricky to diagnose.....I have a good friend/patient who several years ago started to get facial numbness, upper limb weakness, blurred vision, disorientation/confusion and developed a stutter which she never had before......the diagnoses was never confirmed...she had MRI's galore which did not show anything.
I think her Babinski was normal....but not sure (I will check tomorrow in my note)
The three possible diagnoses' that were offered were:
MS
CVA
Stress

She was under enormous pressure at the time and losing a good friend and losing her home.....husband works away 90% of the time and 3 kids.
The good news is that it is now ten yesrs on and she has not had any recurrances and no residual problems...her life is on track again

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Permalink Reply by Mary on June 29, 2008 at 10:10pm

I'm no clinician, but I came across this article in Neurology 2005: 'Should the Babinski sign be part of the routine neurologic examina... and see also 'Highlight and Commentary: The Babinski sign: Thumbs up or toes down?'

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