Babinski Sign

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In addition to the famous sign described by Joseph Babinski, which is also known as Babinski's reflex, there are references in the literature to various other signs described by this famous disciple of J-M Charcot. This article reviews all the neurological signs described by Babinski.

For many authors Joseph Babinski (Fig 1) was, without a shadow of a doubt, Charcot's favorite pupil. However, because of countless political and institutional problems, Joseph Babinski did not succeed Charcot as the chair of diseases of the nervous system in the Paris Medical School. After the death of his mentor Charcot in 1893 and having failed to climb the academic ladder, Babinski became head of the department of neurology at La Pitié Hospital in Paris, France. In this service he carried out a great number of clinical studies, particularly in the area of neurological semiology, and described various signs of cerebellar syndrome and diseases such as the Babinski-Fröhlich syndrome, as well as the reflex that bears his name and made him famous throughout the world1,3-6.

In 1879, after completing his basic medical studies, Babinski became a clinical physician at the Hospital Salpêtrière in Paris. During his first years in this position, Babinski combined his duties as a clinical physician with his morphological studies and published a thesis on the pathological anatomy of multiple sclerosis in 18853. In the same year, much to his disappointment, his thesis came second in a competition organized by the hospitals of Paris, but he was then appointed head of the neurology clinic in professor Charcot's service even though he had never been his intern. Following that contact, Babinski started to share Charcot's interest in studying different neurological diseases. He used the anatomoclinical method proposed by his master, Charcot, and was particularly interested in discovering ways of distinguishing between the signs and symptoms of hysteria and those of organic neurological conditions.

Also in 1898, Babinski wrote an improved paper in which he added the following observations: in healthy individuals the hallux may not move after the stimulation; the response may vary depending on the area of the sole of the foot that is stimulated, a greater response being observed if stimulation occurs in the lateral region; and the presence of the sign excludes a diagnosis of hysteria3,11,12,17,18.

The consistency of the reflex described by Babinski and its variants has been confirmed in different studies in the literature, in particular the study by Singerman and Lee, who evaluated 38 individuals, all of whom were examined by six neurologists, and confirmed that Babinski's sign has a high inter-observer consistency18.

Since the classic description of Babinski's sign, various other authors have described the use of different techniques with different excitation sites to detect Babinski's sign, each technique subsequently being given the name of the author who described it3,10. Hence, there are more than 30 \"equivalents\" to or rivals of Babinski's sign3,10. Table shows the main substitutes for this sign described to date, the best-known being Chaddock's sign (stroking the skin beneath the lateral malleolus), Oppenheim's sign (stroking the tibial surface) and Gordon's sign (compression of the calf muscle)3,10,20. There is even a substitute for Babinski's sign described in 1912 by a Brazilian neurologist that is known as Austregésilo and Esposel's sign (stimulation of the thigh)3,10,21.

In addition to the classic sign described by Babinski, there are five other less well-known signs that are also referred to as Babinski's sign. Four of these are described in the Dorland's Medical Dictionary. All five are described below:

[1] Babinski's sign (sciatica/hysteria): Loss or lessening of the Achilles' tendon reflex in sciatica - this distinguishes it from hysterical sciatica. This sign was published in 1896 (Bulletins et Mémoires de la Société Medicale des Hôpitaux de Paris 1896; (XIII): 887-889), as \"Abolition du réflexe de tendon d'Achille dans la sciatique\"3,22,23.

[2] Babinski's sign' (hemiplegia): In hemiplegia, contraction of the platysma muscle in the healthy side is more vigorous than on the affected side, as seen in the opening of the mouth, whistling and blowing (Babinski J. \"Sur le spasme du peaucier du cou\". Rev Neurol (Paris); 1901(IX):693-6963,22,24. Leon-Sarmiento et al. published a case with two Babinski's signs (the classic sign and the \"platysma\" sign) in a female patient with hemiplegia (after a stroke)25. In 2008 the same authors published another paper about the presence of two Babinski's signs in patients with tropical spastic paraparesis and called this combination of signs the Babinski plus sign26.

[3] Babinski's sign (hemiplegia): When a hemiplegic patient is lying with arms crossed upon the chest and makes an effort to sit up, the thigh on the paralyzed side is flexed upon the pelvis and the heel is lifted from the ground, while on the healthy side the limb does not move3,22,27.

[5] Babinski's sign (facial hemispasm): With facial hemispasm one may observe a paradoxical raising of the eyebrow during eye closing. (Babinski J. \"Hémispasme facial périphérique\". Rev Neurol (Paris); 1905 (XIII): 443-4503,22,29. In recent years papers about this sign have been published by other authors, such as Devoize in 200130 and Stamey and Jankovic in 200731.

In conclusion, six signs have been published under the name Babinski's sign. These include the classic Babinski's sign, also known as the toe phenomenon, and five other Babinski's signs: those described in cases of sciatica and hemiplegia, the platysma sign (in hemiplegia), the pronator sign (in hemiplegia) and the Babinski's sign that occurs in hemifacial spasm.

Meanwhile, cervical myelopathy also shows sensory disturbance in the limbs, and bladder dysfunction. Most of severe-diabetic patients already have sensory disturbance in the limbs, and bladder dysfunction, therefore these findings cannot be used to clarify the presence of cervical myelopathy in patients suffering from DM. Furthermore, deep tendon hyperreflexias that are the typical signs for cervical myelopathy will not be apparent in patients with DM (as per above). Thus, the diagnosis of cervical myelopathy in patients suffering from DM is difficult.

Some previous reports described the differences in the neurological findings for cervical myelopathy between diabetic and non-diabetic patients.1, 2 However, none of these previous reports provide information regarding signs that could help aid the diagnosis of cervical myelopathy in patients with DM. In these previous studies patients with mild and severe degree of DM were mixed together.

Comparison of the change in Japanese Orthopaedics Association Score scores of motor function at upper extremities between pre and postop among the three groups. There is no significant difference in the change of JOA score of motor function at upper extremities between pre and postop among the three groups.

There were no significant differences in both sensory disturbance and bladder dysfunction among the three groups. This suggests that we were not able to detect the presence of cervical myelopathy in DM patients by either the degree of sensory disturbance or the presence of bladder dysfunction. Thus, both sensory disturbance and bladder dysfunction are not helpful in making the diagnosis for cervical myelopathy in patients suffering from DM. These indicate that we should not expect a postoperative improvement in either sensory disturbance or bladder dysfunction by decompression surgery.

The Babinski reflex is also called the Babinski sign, Babinski response, Babinski phenomenon, plantar response, plantar reflex, or the big toe sign. It is named for French neurologist Joseph Francois Felix Babinski (1857-1932).

If the Babinski reflex occurs on one side but not the other, it points to a problem with one side of the brain. Whenever the Babinski sign is present in adults and older children, more testing should be done to determine the cause of the abnormality.

When the Babinski reflex is present in a child older than 2 years or in an adult, it is often a sign of a central nervous system disorder. The central nervous system includes the brain and spinal cord. Disorders may include:

Use a dull or blunt instrument to run up the lateral plantar aspect of the foot from the heel to the little toe and across the metatarsal pad to the base of the great toe. If there is extension (upward movement or dorsiflexion) of the great toe with or without fanning of the other toes, Babinski reflex is said to be present. If the toes deviate downward the reflex is absent. If there is no movement this is considered a neutral response and has no clinical significance 1,2.

In infants with an incompletely myelinated corticospinal tract the Babinski reflex may be present up to 24 months of age which is considered normal in the absence of other neurological signs or symptoms 1.

Methods: We examined 182 patients with HFS prospectively for the presence of the Babinski-2 sign. We then evaluated its correlation with variables including sex and side of the HFS and facial paralysis. All assessments were performed by video recording by two movement disorder specialists.

Conclusions: The Babinski-2 sign, found in 34.6 % of our patients with HFS, is an under-recognized physical sign which can be used to distinguish HFS from other facial movement disorders including blepharospasm. The treatment of HFS with Babinski-2 should include injecitons of corrugator muscle on the affected side.

Acquired acute demyelinating peripheral polyneuropathy (AADP) is a general classification of pathologies that could affect secondary the peripheral nervous system. They are characterized by an autoimmune process directed towards myelin. Clinically they are characterized by progressive weakness and mild sensory changes. Acute inflammatory demyelinating polyneuropathy often is referred to as Guillain-Barré syndrome (GBS). GBS is the major cause of acute nontraumatic paralysis in healthy people and it is caused by autoimmune response to viral agents (influenza, coxsackie, Epstein-Barr virus, or cytomegalovirus) or bacterial infective organisms (Campylobacter jejuni, Mycoplasma pneumoniae). A detailed history, with symptoms of progressive usually bilateral weakness, hyporeflexia, with a typical demyelinating EMG pattern supports the diagnosis. Progressive affection of respiratory muscles and autonomic instability coupled with a protracted and unpredictable recovery normally results in the need for ICU management. We present a case report of a patient with a typical GBS presentation but with a unilateral upgoing plantar reflex (Babinski sign). A unifying diagnosis was made and based on a literature search in Pubmed appears to be the first described case of its kind. 59ce067264

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