Synchronized Babinski and Chaddock signs preceded the MRI findings in a case of repetitive transient ischemic attack.

We herein report a 53-year-old female with repeated transient ischemic attack (TIA) symptoms including 13 instances of right hemiparesis that decreased in duration over 4 days. Two separate examinations using diffusion weighted image (DWI) in magnetic resonance imaging (MRI) revealed normal findings, but we observed that both Babinski and Chaddock signs were completely synchronized with her right hemiparesis. We were only able to diagnose this case of early stage TIA using clinical signs. This diagnosis was confirmed 4 days after the onset by the presence of abnormalities on the MRI. DWI-MRI is generally useful when diagnosing TIA, but a neurological examination may be more sensitive, especially in the early stages.

Diagnostic pathway to amyotrophic lateral sclerosis (ALS): the significance of Babinski's sign in a unique patient and the necessity for a multidisciplinary approach.

In this case report, we present a patient with rare diagnosis of amyotrophic lateral sclerosis (ALS). In this patient, four different neurological disorders were diagnosed in a short-time period of 8 months. The first three diagnoses, chronic low back and leg pain, a left frontal gemistocytic astrocytoma WHO grade 2 and suspected Lyme's disease, could not fully explain the signs of physical examination. Finally, the diagnosis of ALS could reduce these signs to the same denominator.

The plantar reflex: additional value of stroking the lateral border of the foot to provoke an upgoing toe sign and the influence of experience.

The aim of this work was to determine the value of stroking the lateral dorsal border of the foot, in addition to stroking the sole in patients with a suspected pyramidal tract lesion. In addition, we studied the differences in interpretation between neurologists, residents, and medical students. We included subjects who had weakness of at least one leg and in whom a pyramidal tract lesion was suspected. After testing muscle power, tone, reflexes, and foot tapping, a decision on the presence of a pyramidal syndrome had to be made by each observer. After stimulating the sole as well as the lateral border of the foot, observers made a decision about the presence of a pyramidal syndrome again. Twenty-two legs of 18 patients were examined. Testing the plantar reflex (according to both methods) led to a change of opinion on the presence of a pyramidal syndrome in 45 of 69 (65 %) observations. On analysis according to level of experience, a change of opinion occurred in 19 (86 %) observations by medical students, 15 (65 %) by residents, and 11 (46 %) by neurologists. On eight occasions, the change was prompted by stimulation of the lateral border; in five of these cases the examiner (three medical students and two residents) found a new pathological response. Consecutively stroking the sole and the lateral border may be of added value, especially for less-experienced physicians. It seems that more-experienced physicians need fewer tests in the physical examination in order to identify a pyramidal syndrome of the leg.

Doze sinais de Babinski: História da Neurologia e Neurossemiologia / Babinski’s twelve signs: History of Neurology and Neurosemiology

Este artigo tem como finalidade contar um pouco da história daquele que é considerado o pai de semiologia neurológica, e relembrar doze dosseus sinais, a maioria dos quais voltados para a diferenciação entre as doenças orgânicas e conversivas.

This article aims to tell a small story of who is considered the ?father of neurological examination?, and remember twelve of his signs, most of which focused on the differentiation between organic diseases and hysteria.

[Hemiplegia with two Babinski's sign]. / Hemiplejía con dos signos de Babinski.

Neurological signs and symptoms are very important to establish a correct neurological diagnosis. We present here a Colombian female patient, 60 years-old, who had ischaemic stroke in the left cerebral media artery. It produced right hemiplegia, motor aphasia, "central" facial palsy and atrophy of right platysma muscle. This latter finding, described originally by Joseph Babinski as "The Babinski Sign" was observed only two years and seven months after the ictus even when she had, previously, been evaluated by several neurologists. The underdiagnosis of clinical signs like the one described here may lead to erroneous diagnosis that will, ultimately, affect neurorehabilitation measures.

Hemiplejía con dos signos de Babinski / Hemiplegia with two Babinski´s sign

La evaluación semiológica apropiada es uno de los aspectos más importantes para realizar un adecuado diagnóstico neurológico. Presentamos una paciente colombiana de 60 años de edad, quien padeció un infarto de la arteria cerebral media izquierda, originándole hemiplejía derecha, afasia motora, parálisis facial "central" derecha y atrofia del músculo platisma derecho. Este último hallazgo, originalmente descrito por Joseph Babinski, el cual es el verdadero signo de Babinski, no fue identificado sino hasta dos años y siete meses después de haberse presentado el ictus, aunque había sido evaluada, previamente, por diferentes especialistas en ciencias neurológicas. La no identificación de signos como el mencionado aquí lleva, en ocasiones, a realizar diagnósticos erróneos o incompletos afectando no sólo la localización apropiada de las lesiones sino, también, las eventuales medidas que se deben tomar en la neurorrehabilitación de estos pacientes.

Neurological signs and symptoms are very important to establish a correct neurological diagnosis. We present here a Colombian female patient, 60 yearsold, who had ischaemic stroke in the left cerebral media artery. It produced right hemiplegia, motor aphasia, "central" facial palsy and atrophy of right platysma muscle. This latter finding, described originally by Joseph Babinski as "The Babinski Sign" was observed only two years and seven months after the ictus even when she had, previously, been evaluated by several neurologists. The underdiagnosis of clinical signs like the one described here may lead to erroneous diagnosis that will, ultimately, affect neurorehabilitation measures.

Hemiplejía con dos signos de Babinski / Hemiplegia with two Babinski´s sign

La evaluación semiológica apropiada es uno de los aspectos más importantes para realizar un adecuado diagnóstico neurológico. Presentamos una paciente colombiana de 60 años de edad, quien padeció un infarto de la arteria cerebral media izquierda, originándole hemiplejía derecha, afasia motora, parálisis facial "central" derecha y atrofia del músculo platisma derecho. Este último hallazgo, originalmente descrito por Joseph Babinski, el cual es el verdadero signo de Babinski, no fue identificado sino hasta dos años y siete meses después de haberse presentado el ictus, aunque había sido evaluada, previamente, por diferentes especialistas en ciencias neurológicas. La no identificación de signos como el mencionado aquí lleva, en ocasiones, a realizar diagnósticos erróneos o incompletos afectando no sólo la localización apropiada de las lesiones sino, también, las eventuales medidas que se deben tomar en la neurorrehabilitación de estos pacientes.(AU)

Neurological signs and symptoms are very important to establish a correct neurological diagnosis. We present here a Colombian female patient, 60 yearsold, who had ischaemic stroke in the left cerebral media artery. It produced right hemiplegia, motor aphasia, "central" facial palsy and atrophy of right platysma muscle. This latter finding, described originally by Joseph Babinski as "The Babinski Sign" was observed only two years and seven months after the ictus even when she had, previously, been evaluated by several neurologists. The underdiagnosis of clinical signs like the one described here may lead to erroneous diagnosis that will, ultimately, affect neurorehabilitation measures.(AU)

Should the Babinski sign be part of the routine neurologic examination?

BACKGROUND: The Babinski sign is a well-known sign of upper motor neuron dysfunction that is widely considered an essential element of a complete neurologic examination. Little is known about reliability and validity of this sign. A less well-known sign of upper motor neuron dysfunction, decreased speed of foot tapping, also has not been carefully evaluated. Scientific evaluation of findings of the physical examination is crucial in directing busy clinicians. METHODS: Ten physicians (five neurologists and five non-specialists) examined each foot of 10 subjects, 8 of whom had known unilateral upper motor neuron weakness, 1 had bilateral leg weakness secondary to ALS, and 1 had no known neurologic deficits. Our main outcome measures were inter-rater reliability (kappa values) and accuracy (agreement with known upper motor neuron weakness). RESULTS: The reliability of the Babinski sign was fair (kappa 0.30) and was substantial for foot tapping (kappa 0.73). Agreement with known weakness was 56% for Babinski sign and 85% for foot tapping. Reliability and accuracy for both tests were similar for neurologists and non-specialists. CONCLUSIONS: The interobserver reliability and validity of the Babinski sign for identifying upper motor neuron weakness are limited. Slowness of foot tapping may be a more useful sign.

[Babinski and Chaddock signs without apparent pyramidal disfunction]. / Sinais de Babinski e Chaddock sem disfunção piramidal aparente.

PURPOSE: The main objective of this study was to verify, in one hundred in-patients from the Serviço de Clínica Médica do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro who did not have a history of clinical symptoms of pyramidal disfunction, the presence of the Babinski and Chaddock signs. As a secondary objective, we looked for a prevalence of one of the signs over the other, and the influence of the head position regarding the obtained responses. METHOD: The patients were examined while supine with their heads in three different positions. RESULTS: Out of the one hundred patients, ten of them (10%) showed hallux extension uni or bilateral. The Babinski sign was positive 18 times (40%), and the Chaddock sign was positive 27 times (60%). CONCLUSION: The Chaddock sign occurred more frequently than the Babinski sign, the abnormal reflex occurred twice as much on the left foot than the right, and apparently there was no interference regarding the head position in relation to the obtained results.

Sinais de Babinski e Chaddock sem disfunção piramidal aparente / Babinski and Chaddock signs without apparent pyramidal disfunction

OBJETIVO: Verificar a presença dos sinais de Babinski e de Chaddock em cem pacientes sem história ou indícios clínicos de comprometimento da via piramidal, internados no Serviço de Clínica Médica do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. Como objetivos secundários, observar a possível prevalência de um sinal sobre o outro, assim como a influência da posição da cabeça sobre as respostas obtidas. MÉTODO: Cada um dos sinais foi pesquisado por um único autor, utilizando o mesmo instrumento, estando os pacientes em decúbito dorsal e com a cabeça em três posições. RESULTADOS: Em dez pacientes (10 por cento) obteve-se a resposta de extensão do hálux uni ou bilateral. O sinal de Babinski apresentou-se 18 vezes (40 por cento) e o sinal de Chaddock 27 vezes (60 por cento). CONCLUSÃO: O sinal de Chaddock foi o mais freqüente. As respostas anormais ocorreram duas vezes mais à esquerda e, aparentemente, não houve interferência da posição cefálica em relação às respostas obtidas.

Babinski-Nageotte's syndrome and Hemimedullary (Reinhold's) syndrome are clinically and morphologically distinct conditions.

A hemimedullary infarction, in which medial and lateral medullary lesions occur simultaneously, is a rare cerebrovascular disease. It has been suggested that the Babinski-Nageotte's syndrome is the classical brainstem syndrome that corresponds to hemimedullary lesion. In this study we compare clinical symptoms and magnetic resonance imaging (MRI) data of two patients exhibiting classical Babinski-Nageotte's syndrome according to the original description with symptoms and MRI data of a patient with clinically complete hemimedullary lesion. Our study shows that Babinski-Nageotte's syndrome is neither clinically nor on MRI identical with hemimedullary lesion. Hypoglossal palsy, an invariable symptom of hemimedullary syndrome, is not part of the Babinski-Nageotte's syndrome according to the original description. Consistent with the original historical report, Babinski- Nageotte's syndrome is a lateral "Wallenbergian" medullary lesion with a spreading of the lesion to the more basal localised pyramidal tract. The clinical features of the hemimedullary syndrome, described in 1894 by Reinhold, and the MRI appearances in our patient with this syndrome are clearly different from other classical brainstem syndromes and should be called Reinhold's syndrome.

The frequency and significance of 'striatal toe' in parkinsonism.

A striatal toe has been defined as an apparent extensor plantar response, without fanning of the toes, in the absence of any other signs suggesting dysfunction of the cortico-spinal tract. Little is known about the frequency and significance of this sign in parkinsonian syndromes. We prospectively examined 62 patients (Parkinson's disease: other akinetic-rigid syndromes=38:24) for the presence or absence of striatal toe and extensor plantar responses, as defined by Babinski. Details of the history, physical findings and investigations previously undertaken were rated and examined for their relevance to the response obtained from the hallux. Of the 62 patients, 17 patients showed an upgoing plantar response, of whom 13 (Parkinson's disease: other akinetic-rigid syndromes=7:6) had striatal toes, either unilateral (10) or bilateral (3). The remaining four patients showed a classical Babinski sign (Parkinson's disease: other akinetic-rigid syndromes=2:2). There was no lateralising relationship between lesions of the basal ganglia found on imaging and the side of the striatal toe, or the side of dyskinesias found at the time of examination. However, there appeared to be a greater frequency of dyskinesias and evidence of lesions involving the basal ganglia on imaging in patients with striatal toes compared with those who showed a plantar response other than upgoing. The possible relevance of these findings is discussed.

The Babinski sign--a reappraisal.

In 1896, Joseph Babinski, a French neurologist, first described the best known neurologic eponym 'the Babinski sign'. This sign is characterised by dorsiflexion of the big toe and recruitment of the extensor hallucis longus muscle, on stimulating the sole of the foot. He has emphasised from the outset, the intimate relationship between this sign and the shortening movement in other leg muscles, which form the flexion synergy of the lower limb. The Babinski sign is not a new reflex, rather it is released as a result of breakdown of the harmonious integration of the flexion and extension components of the normal defence reflex mechanism, due to pyramidal tract dysfunction. A pathological Babinski sign should be clearly distinguished from upgoing toes that may not always be a part of the flexion synergy. This article reviews the Babinski sign in detail, focusing on the historical perspectives, role of pyramidal tract dysfunction and art of elicitation and interpretation. The significance of assessing this phenomenon in the entire leg, and the clinical clues that will help to dispel the myths regarding the Babinski sign, have been emphasised.