Babinski sign

Which variant of Babinski sign is elicited by squeezing calf ?

A. Chaddock sign

B. Gordon sign

C. Oppenheim sign

D. Throckmorton sign

Babinski Reflex

What is the clinical significance  of Babinski sign?

Babinski reflex tests the integrity of the corticospinal tract

How to elicit Babinski  sign?

Babinski sign is  elicited by a dull, blunt instrument- the instrument is run up the lateral plantar side of the foot from the heel to the toes, and across the metatarsal pads to the base of the big toe.

Response of Babinski  sign –

When Babinski reflex is present it shows –

Dorsiflexion (upward movement) of the big toe and fanning of the other toes.

When this occurs, then the Babinski reflex is present.

Babinski sign is positive in patients with pyramidal tract dysfunction.

Normal Response -If the toes deviated downward, then the reflex is absent. Which is a normal response.

Final Result for a POSITIVE SIGN is – dorsiflexion of the big toe.

Upward movement of the toe is pathological only if caused by contraction of extensor hallucis longus muscle.

Corticospinaltract originated from which place?

Corticospinaltract is a descending fiber tract that originates from the cerebral cortex through the brainstem and spinal cord. 

Primary motor cortex, premotor areas, and supplementary motor areas – 60% of the CST fibers originate  

The remainder originates from primary sensory areas, the parietal cortex, and the operculum.

The motor response which leads to the plantar flexion is mediated through which root?

S1 root and tibial nerve.

Why is Babinski sign considered normal up to 24 months of age  in the absence of other neurological deficits ?

In infants with at CST which is not fully myelinated the presence of a Babinski sign in the absence of other neurological deficits is considered normal up to 24 months of age. 

Babinski’s may be present when a patient is asleep.

Which clinical situations Babinski signs are important to be evaluated?

Babinski reflex is especially important in the setting where there is suspicion of spinal cord injury or stroke,

Damage anywhere along the CST can result in the presence of a Babinski sign.

Babinski reflex positive or Extensor reflex has been observed in structural lesions such as

• Hemorrhage,
• Crain and spinal cord tumors,
• Multiple sclerosis,
• Abnormal metabolic states such as hypoglycemia, hypoxia, and anesthesia

What is the extent of UMN?

Fibers from the CST synapse with the alpha motor neuron in the spinal cord and help direct motor function. 

The CST is considered the upper motor neuron (UMN) and the alpha motor neuron is considered the lower motor neuron (LMN).

What are the Variations of the Babinski sign ?

• Chaddock sign – stimulating under lateral malleolus
• Gordon sign- squeezing calf
• Oppenheim sign- applying pressure to the medial side of the tibia
• Throckmorton sign- hitting the metatarsophalangeal joint of the big toe

Each of them designed to elicit dorsiflexion of the big toe when indicates positive sign.

What are the Non- Neurological Causes of Extensor Plantar Response?

• In children upto the age of 1 year
• Coma
• General anaesthesia
• Electroconvulsive therapy
• Post-ictal stage of epilepsy
• Apnoeic phase of Cheyne Stockes breathing
• Hypoglycemia
• Drugs-scopalamine, barbiturates