REFLEXES THE CODES OF NEUROLOGY

reflexesneurologytaskindumankapak21432

PATHOLOGICAL REFLEXES

Derya Yavuz Demiray

Hatay Mustafa Kemal University, Faculty of Medicine, Department of Neurology, Hatay, Türkiye

Yavuz Demiray D. Pathological Reflexes. In: Duman T, editor. Reflexes The Codes of Neurology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.231-242.

ABSTRACT

The Babinski sign, a hallmark of neurological examination, has played a pivotal role in identifying corticospinal tract impairments since its discovery in 1896 by Joseph Babinski. This reflex, manifesting as dorsiflexion of the great toe and fanning of the lesser toes upon stimulation of the sole, serves as a critical indicator of upper motor neuron lesions. Its relevance extends beyond pathology, with physiological variations observed in infants due to incomplete myelination. This paper provides a comprehensive exploration of the Babinski sign’s historical evolution, anatomical basis, clinical procedures and pathophysiological implications. Additionally, it highlights various Babinski sign equivalents, developed to enhance diagnostic precision in pyramidal tract disorders. These include Chaddock’s, Oppenheim’s and gordon’s signs, among others, each targeting specific anatomical reflexogenic zones. Despite advancements in neuroimaging and electrophysiology, the Babinski sign and its variants remain indispensable in modern neurology, offering nuanced insights into corticospinal tract dysfunction while underscoring the need for standardized techniques to maximize diagnostic reliability.

Keywords: Pathological reflexes; Plantar reflex; Babinski reflex; Babinski equivalents; Chaddock reflex; hoffman reflex; gordon sign; Oppenheim sign

Referanslar

  1. Walker HK. The Plantar Reflex. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 73. Available from: nlm.nih.gov/books/NBK397/ [Link]
  2. Sternbach G. Joseph Babinski: the phenomenon of the toes. J Emerg Med. 1984;1(3):263-266. [Crossref]  [PubMed]
  3. Babinski, J Sur le réflexe cutané plantaire dans certaines affections organiques du système nerveux central C R Seances Soc Biol Fil. 1896;48:207-208 [Crossref]  [PubMed]
  4. Mehndiratta MM, Bhattacharyya KB, Bohra V, Gupta S, Wadhwa A. Babinski the great: Failure did not deter him. Ann Indian Acad Neurol. 2014;17(1):7-9. [Crossref]  [PubMed]
  5. Van Gijn, J; The Babinski sign: the first hundred years, J Neurol. 1996;243:675-683. [Crossref]  [PubMed]
  6. AbuHasan Q, Munakomi S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL). 2023. Neuroanatomy, Pyramidal Tract. [Crossref]
  7. Natali AL, Reddy V, Bordoni B. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): 2023. Neuroanatomy, Corticospinal Cord Tract.
  8. Landau W. Clinical definition of the extensor plantar reflex (letter). N Engl J Med. 1971;285:1149-50. [Crossref]  [PubMed]
  9. Acharya AB, Jamil RT, Dewey JJ. Babinski Reflex. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2024 Jan-. [Crossref]  [PubMed]
  10. Dejong RN. The neurologic examination. 4th ed. New York: Harper&Row. 1979;451-63.
  11. Khadilkar SV, Chheda AH. A systematic and quantitative evaluation of plantar stimulation: The effect of type, pattern, force of stimulation in eliciting an accurate plantar response. Clin Neurol Neurosurg. 2018;168:83-90. [Crossref]  [PubMed]
  12. Ross ED, Velez-Borras J, Rosman NP . The significance of the Babinski sign in the newborn: a reappraisal. Pediatrics 1976;57:13-15. [PubMed]
  13. Dohrmann GJ, Nowack WJ. The upgoing great toe: optimal method of elicitation. Lancet. 1973; 339-41. [Crossref]  [PubMed]
  14. Morrow JM, Reilly MM. The Babinski sign. Br J Hosp Med (Lond). 2011;72(10):157-9. [Crossref]  [PubMed]
  15. Kumar S P, Ramasubramanian D. The Babinski sign-a reappraisal. Neurol India. 2000;48:314-8. [Crossref]  [PubMed]
  16. Chaddock CG. A preliminary consideration concerning a new diagnostic nervous sign. Interstate Med J. 1911;12:742746. [Crossref]  [PubMed]
  17. Fujiki A, Shimizu A, Yamada Y, Yamamoto J, Kazaneko Z. The Babinski reflex during sleep and wakefulness. Electroencephalography and Clinical Neurophysiology 1971;31: 610-613. [Crossref]  [PubMed]
  18. Grimby L, Kugelberg E, Lofstrom B. The plantar response in narcosis. Neurology 1966;16:139-144. [Crossref]  [PubMed]
  19. Walczak TS, Rubinsky M. Plantar responses after epileptic seizures. Neurology 1994;44:2191-2193. [Crossref]  [PubMed]
  20. Van Gijn J. The Babinski sign and the pyramidal syndrome. J Neurol Neurosurg Psychiatry. 1978;41(10):865-73. [Crossref]  [PubMed]
  21. Chew KS, Onn LL, Lee RA, Lim KS, Tan CT. Withdrawal response in healthy adults. Neurol Asia. 2010;15(2):159-65.
  22. Rehman HU. Babinski sign. Neurologist. 2002;8(5):316-8. [Crossref]  [PubMed]
  23. Weaver RA, Landau WM, Higgins JF. Fusimotor function. Part II. Evidence of fusimotor depression in human spinal shock. Arch Neurol 1963;9:127-132. [Crossref]  [PubMed]
  24. MaranhãoFilho P, Dib E, Ribeiro RG. Babinski and chaddock signs without apparent pyramidal disfunction. Arq Neuropsiquiatr 2005;63:4847.
  25. Winkler AS, Reuter I, Harwood G, Chaudhuri KR. The frequency and signifcance of “striatal toe” in parkinsonism. Parkinsonism Relat Disord. 2002;9:97-101. [Crossref]  [PubMed]
  26. Isaza Jaramillo SP, Uribe Uribe CS, García Jimenez FA, Cornejo Ochoa W, Alvarez Restrepo JF, Román GC, et al. Accuracy of the babinski sign in the identification of pyramidal tract dysfunction. J Neurol Sci 2014;343:668. [Crossref]  [PubMed]
  27. Appasamy PT, Dan TA, Bandyopadhyay V, Mathew V, Jeyaseelan V, Babu S, et al. Accuracy and reliability of Babinski sign versus finger and foot tapping in the diagnosis of corticospinal tract lesions. Neurol India. 2018;66(5):1377-1380. [Crossref]  [PubMed]
  28. Miller TM, Johnston SC. Should the Babinski sign be part of the routine neurologic examination? Neurology. 2005;65:1165-8. [Crossref]  [PubMed]
  29. Deng T, Jia JP, Zhang T, Guo D, Yang L. Cortical versus non-cortical lesions affect expression of Babinski sign. Neurol Sci. 2013;34(6):855-9. [Crossref]  [PubMed]
  30. Acharya AB, Fowler JB. Chaddock Reflex. 2023 . In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2024 Jan–. [Crossref]  [PubMed]
  31. Tashiro K. Kisaku Yoshimura and the Chaddock reflex. Arch Neurol. 1986;43(11):1179-80. [Crossref]  [PubMed]
  32. Oppenheim H. Aur Pathologie der Hautreflexe an der unteren Extremitaten. Monatsschr Psychiatri Neurol. 1902;12:421-423. [Crossref]  [PubMed]
  33. Gordon A. A new reflex: paradoxic flexor reflex and its diagnostic value. Am Med. 1904;8:971. [Crossref]  [PubMed]
  34. Schaefer Ueber einen antagonistischen Reflex. Neurol Centratbl. 1899;18:1016-1018.
  35. Stransky E, Eine Abart des Babinskischen Reflexes. Nervenarzt; 1933;6:596.
  36. Mendel K. Bemerknngen zur vorstehenden Mitteilung. Neurol Centralbl. 1904;23:610-611.
  37. Bechterew W. Ober einen besonderen Beugereflex der Zehen. Neurol Centralbl. 1904;23:609-610.
  38. Satran RGI. Rossolimo (1860-1928). J Neurol. 2005;252:1423-1424. [Crossref]  [PubMed]
  39. Moniz E. Le signe de ta flexion plantaire du gros orteil avec la jambe en flexion. Rev Neurol (Paris). 1916;30:173-176. [Crossref]
  40. Davis AP, Wettstein A, Swanson PD, Longstreth WT Jr. The search for the elusive Bing sign. Neurology. 2018;91(8):354-356. [Crossref]  [PubMed]
  41. Strümpell AV. Ueber das Verhalten der Hautund Sehnenreflexe bel Nervenkranken. Neur Cbl. 1899;18:617-619. [Crossref]  [PubMed]
  42. Ambesh P, et al. The Babinski Sign: A comprehensive review.Journal of the Neurological Sciences. 2017;372:477-481. [Crossref]  [PubMed]
  43. Aguiar T, Maranhão Filho P. The Brissaud sign. Arq Neuropsiquiatr. 2014;72:471. [Crossref]  [PubMed]
  44. Throckmorton TB A new method for eliciting the extensor toe reflex. JAMA. 1911;56:1311-1312. [Crossref]  [PubMed]
  45. Cook CE, Wilhelm M, Cook AE, Petrosino C, Isaacs R. Clinical Tests for Screening and Diagnosis of Cervical Spine Myelopathy: A Systematic Review. Journal of Manipulative and Physiological Therapeutics. 2011;34(8),539-546. [Crossref]  [PubMed]
  46. Sharma C, Acharya M, Kumawat BL, Agarwal P. Puusepp’s sign: a Babinski’s sign equivalent. BMJ Case Rep. 2014:bcr2014203834. [Crossref]  [PubMed]
  47. Wartenberg R. Babinski reflex and Marie-Foix flexor withdrawal reflex; historical notes. AMA Arch Neurol Psychiatry. 1951;65(6):713-6. [Crossref]  [PubMed]
  48. Castillo-Torres SA, Flores-Alfaro F, Góngora-Rivera F. Another one that extends the toe: the Austregésilo-Esposel sign. Arq Neuropsiquiatr. 2021;79(11):1062-1063. [Crossref]  [PubMed]
  49. Aubert G. Arthur Van Gehuchten (1861-1914). J Neurol. 2001;248(5):439-40. [Crossref]  [PubMed]
  50. Hachinski V. The upgoing thumb sign. Arch Neurol. 1992;49:346. [Crossref]  [PubMed]
  51. Hindfelt B, Rosén I, Hanko J. The significance of a crossed extensor hallucis response in neurologic disorders: a comparison with the Babinski sign. Acta Neurol Scand. 1976;53(4):241-50. [Crossref]  [PubMed]
  52. Van Munster CEP, Weinstein HC, Uitdehaag BMJ, et al. The plantar reflex: additional value of stroking the lateral border of the foot to provoke an upgoing toe sign and the influence of experience. J Neurol. 2012;259:2424-2428. [Crossref]  [PubMed]
  53. Tashiro K. Clinical evaluation of pathological reflexes, with special reference to the Chaddock reflex. Neurol Med 1981;14:556-561 (in Japanese) . [PubMed]
  54. Van Thanh L .Modification of the Babinski phenomenon (in Czech). Ceskoslov Neurol Neurochir. 1973;36:399-402. [PubMed]
  55. Lenggenhager K. Ueber einen neuen, sehr empfindlichen Reflex bei Druck auf die motorischen Bahnen im Zentralnervensystem. Schweiz Arch Neurol Psychiatr. 1945;75:693694.
  56. Whitney E, Munakomi S. Hoffmann Sign. 2024 Sep 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. 2024. [Crossref]  [PubMed]
  57. Boyraz I, Uysal H, Koc B, Sarman H. Clonus: definition, mechanism, treatment. Med Glas (Zenica). 2015;12(1):19-26. [PubMed]
  58. Goetz CG. History of the extensor plantar response: Babinski and Chaddock signs. Semin Neurol. 2002;22(4):391-8. [Crossref]  [PubMed]
  59. Ghosh D, Pradhan S. “Extensor Toe Sign” by Various Methods in Spastic Children With Cerebral Palsy. Journal of Child Neurology. 1998;13(5):216-220.
  60. Ashby P, Verrier M, Lightfoot E: Segmental reflex pathways in spinal shock and spinal spasticity in man. J Neurol Neurosurg Psychiatry. 1974;37:1352-1360. [Crossref]  [PubMed]
  61. Van Gijn J. The Babinski reflex. Postgrad Med J. 1995;71(841):645-8. [Crossref]  [PubMed]
  62. Singerman J, Lee L. Consistency of the Babinski reflex and its variants. Eur J Neurol. 2008 Sep;15(9):960-4. [Crossref]  [PubMed]
  63. Araújo R, Firmino-Machado J, Correia P, Leitão-Marques M, Carvalho J, Silva M, Nogueira A, Nunes C. The plantar reflex: A study of observer agreement, sensitivity, and observer bias. Neurol Clin Pract. 2015;5(4):309-316. [Crossref]  [PubMed]
  64. Pearce J, Aziz H, Gallagher JC. Primitive reflex activity in primary and symptomatic Parkinsonism. Journal of Neurology, Neurosurgery & Psychiatry. 1968;31:501-508. [Crossref]  [PubMed]
  65. Walker HK. The Suck, Snout, Palmomental, and Grasp Reflexes. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 71. [Crossref]  [PubMed]
  66. Ropper AH. Unusual spontaneous movements in braindead patients. Neurology. 1984;34:1089-1092. [Crossref]  [PubMed]
  67. Saposnik G, Bueri JA, Mauriño J, Saizar R, Garretto NS. Spontaneous and reflex movements in brain death. Neurology. 2000;11;54(1):221-3. [Crossref]  [PubMed]
  68. Moon JW, Hyun DK. Chronic Brain-Dead Patients Who Exhibit Lazarus Sign. Korean J Neurotrauma. 2017;13(2):153-157. [Crossref]  [PubMed]