babinski sign

[tehdude]

Curious med student here with some probably simple questions. I was doing a neuro exam with an old friend today and found a Babinski sign on both sides. After some further questioning, I found he suffered a fall about 10 years ago and was "completely paralyzed from the waist down for an hour". His primary care physician got an x-ray then sent him for physical therapy. My questions are 1. Was this spinal cord shock? 2. Could this be the cause of a Babinski sign?

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[ALFI]

you don't state if it was positive or negative so with further reading im going with negative...i think more details are needed in such a case like 'did he have a positive babinski prior to the fall", "when he gained use of his legs after the hour, did he have full use"

some people just have a natural negative babinski reflex...i had multiple neuro exams because i also have IIH and i don't have a Babinski reflex or a deep tendon reflex in ankles and knees. so theres just odd people out there minus a few cruicial parts but still awesome people.

 

[burs0028]

The Babinski is a sign, not a test. OP's terminology is correct. Using "positive" or "negative" as you would with a pregnancy test is incorrect.

See wikipedia for details, but beware that when rounding with a neurologist you might get nit-picked on this detail...it's a pet-peeve of mine and several of my co-workers.

 

[ALFI]

Uhmm I hope you would give a med student a more detailed site than wikipedia to do research on. That place is over run by 10 year olds. Good thing I'm not going into neurology still there are other questions that need to be asked

 

[burs0028]

Babinski J. Sur le réflexe cutané plantaire dans certaines affections organiques du système nerveux central. C R Soc Biol 1896;48:207-208

ALFI: I hope you find it a more interesting and educational read than the wiki site I previously recommended. I'm sure you read the site with interest and were left yearning for more rather than making the common mistake of dismissing a reference from a controversial website without actually looking at it and confirming it did not meet its intended goal. I actually found the wiki site on the Plantar Reflex to be very accurate and would be proud to know the 10 year old who authored it.

 

[preDoGuy24]

Agreed, wikipedia is awesome and the article + Burs0028 reply is more than adequate for the explanation the OP requested. Oh and Alfi here in america when it says "fellow" on their status that means completed med school + residency + continuing their training in a subspecialty.

 

[ALFI]

*facepalm* i know what a fellow is but here in Australia we are taught to disregard wiki for any source of information whether it be for research on a medical problem we've not heard of or just something run of the mill but haven't seen in a while....i'm running on just about vapours and about to go to bed...been on nightshift for Volunteer ambos for past 3weeks and been living off chocolate, maccas, coke and mother...

i apologise if there was any signs of disrespect neurology is a hard specialty....i know, i tend to spend alot of time in a neurologists office, work long hard hours and the effort to separate personal and professional especially if working with kids would be hard. in EM we treat em and street em most of the time; fractures, burns, penetrating injuries, MU's (made up's), random body aches and pains, colds, flus, things that a GP can consult about.

 

[Redrox]

In EM we treat em and street em most of the time,

May I just remind you that you are not in EM, you have not started medical school. Perhaps you should be waiting a few more years before trying to answer questions in resident forum.

 

[thepretender67]

Question about the babinski reflex: Do you only care about the action of the big toe? Normal: No movement of the big toe , Abnormal/Babinski present: Upgoing toe. Often times I see variable responses of the other toes digits (2-5), but they should be ignored?

 

[deathmerchant]

To answer the question, Babinski sign( and yes, u don't say positive or negative) in adults shouldn't be ignored. Although in ur case, that person probably had an upper spine contusion( likely C spine, or upper T spine) and subsequent spinal shock then ; and now its causing the Babinski. He probably has increased reflexes and clonus as well. Keep in mind, Plantar could be flexor during the actual spinal shock phase, which can last hours to couple of weeks.

 

[thepretender67]

Should the response in the other toes (non-big toe) ,upgoing or downgoing, to stimulation be ignored?

 

[deathmerchant]

yes those are just components of the plantar reflex, there can be variations. It not always like the classic description, but first movement of big toe is the most specific.

 

[typhoonegator]

There are multiple noxious stimuli that can be applied to interrogate the plantar responses of the foot. The Babinski sign is only truly present when stimulation of the lateral sole of the foot progressing from the heel towards the pad of the foot and then sweeping across the pad towards the hallux elicits an upgoing toe and fanning of the remaining digits. If you get an extensor plantar response by repeatedly pricking the dorsum of the foot with a pin or broken tongue depressor, then you have elicited a Bing sign, not a Babinski. Same for Throckmorton, Oppenheim, or Chaddock, which are some of the other common maneuvers to assess the plantar response. Using the name of the maneuver rather than the response is wasting time on history rather than diagnosing the patient. The different maneuvers are only relevant because in some patients the standard Babinski test is equivocal when the Chaddock might give you the answer you're looking for (as an example). You care about the response a hell of a lot more than the stimulus it took to evoke it. Hell, one of my attendings always talked about the "sock sign", when the toe goes up when you pull their sock off in preparation for the Babinski. You won't find that in the books, but it tells you all you need to know about the plantar response.

I strongly discourage my students from using eponyms or saying positive/negative when possible. Are the toes upgoing or downgoing? Tell me what you did and what their toe did in response. This isn't 1875.