Neuro clinics 30

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Neuro Clinics - 30 Babinski’s sign Dr Pratyush Chaudhuri Supported by Nirmal Clinics

description

Babinski sign

Transcript of Neuro clinics 30

Page 1: Neuro clinics 30

Neuro Clinics - 30Babinski’s sign

Dr Pratyush Chaudhuri

Supported by

Nirmal Clinics

Page 2: Neuro clinics 30

• The test for Babinski’s sign, called Babinski’s test, is running a pointed instrument up the lateral border of the foot and crossing to the medial side over the metatarsal pads.

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• Joseph Jules François Félix Babinski

• Made Hôpital de Salpêtrière in Paris a world famous medical centre in the late nineteenth and early twentieth century

• The others being, among others, Jean-Martin Charcot, Claude Bernard, and Joseph Jules Dejerine

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• As a young student of medicine Babinsky came early to Charcot at the Salpêtrière in Paris.

• Charcot soon recognised the greatness of this distinct observer, who was soon to become his favourite student

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• In the daily clinical work Babinski was an extremely untalkative loner who, during his minute neurological examinations more often than not never uttered a word, sometimes not even afterward.

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An academic row and its consequences

• Charles-Joseph Bouchard (1837-1915)• This slowly growing enmity culminated when Bouchard by a skilful play of academic

intrigue succeeded in outmanoeuvring Babinski, Charcot's favourite student, at the appointment of a "professeur agrégé", a meriting necessary for further advancement to "professeur de la chair", full professor.

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• Babinski also took an interest in the pathogenesis of hysteria and was the first to present acceptable differential diagnostical criteria for separating hysteria from organic diseases.

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• the discovery that while the normal reflex of the sole of the foot consists of a plantar reflex of the toes, an injury to the pyramidal tract will show up in an isolated dorsal flexion of the great toe - Babinski's sign.

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• In 1910 Babinsky demonstrated that a careful study of sensibility conducted according to specified principles without exception led to a diagnosis of level without correction.

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• The Babinski’s sign can indicate upper motor neuron damage to the spinal cord in the thoracic or lumbar region

• brain disease – constituting damage to the corticospinal tract.

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• 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,

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There are three responses possible:

• Flexor: the toes curve inward and the foot everts; this is the response seen in healthy adults (aka a "negative" Babinski)

• Indifferent: there is no response.• Extensor: the hallux dorsiflexes and the other toes fan out – the "positive Babinski's

sign" indicating damage to the central nervous system.

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• Infants will also show an extensor response. A baby's smaller toes will fan out and their big toe will dorsiflex slowly. This happens because the corticospinal pathways that run from the brain down the spinal cord are not fully myelinated at this age, so the reflex is not inhibited by the cerebral cortex. The extensor response disappears and gives way to the flexor response around 12-18 months of age.

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• The Hoffmann's sign is sometimes described as the upper limb equivalent of the Babinski's sign[4] because both indicate upper motor neuron dysfunction. Mechanistically, they differ significantly; the finger flexor reflex is a simple monosynaptic spinal reflex involving the flexor digitorum profundus that is normally fully inhibited by upper motor neurons

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Abnormal reflex seen as extension of the big toe

• Bing's sign – multiple pinpricks on the dorsum of the foot• Cornell's sign – scratching the dorsum of the foot• Chaddock's sign – stroking the lateral malleolus• Gonda's sign – flexing and suddenly releasing the 4th toe• Gordon's sign – squeezing the calf muscle• Moniz sign – forceful passive plantar flexion of the ankle• Oppenheim's sign – applying pressure to the medial side of the tibia• Schaefer's sign – squeezing the Achilles tendon• Stransky's sign – vigorously abducting and suddenly releasing the little toe• Strümpell's sign – patient attempts to flex the knee against resistance• Throckmorton's reflex – percussion over the metatarsopahalangeal joint of the big toe

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Abnormal reflex seen as flexion of toes

• Bekhterev-Mendel reflex – flexion of the 2nd to 5th toes on percussion of the dorsum of the foot

• Rossolimo's sign – exaggerated flexion of the toes induced by rapid percussion on the tips of the toes

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That’s all folks