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Case 12
Published in Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta, Clinical Cases, 2021
Andrew Solomon, Julia Anstey, Liora Wittner, Priti Dutta
On examination of the lower limbs, tone appears reduced throughout. Power is significantly reduced in ankle dorsiflexion, plantarflexion, inversion and eversion, as well as flexion and extension at the knee. All defects are equal bilaterally. Power of the hip movements is normal. Knee and ankle jerks are absent bilaterally. Flexion of the toes is observed on testing of the Babinski sign. Sensation to light touch is normal in all dermatomes. Coordination is poor on all tests conducted and gait appears ataxic in nature. Romberg's test is negative.
The neurological examination
Published in Michael Y. Wang, Andrea L. Strayer, Odette A. Harris, Cathy M. Rosenberg, Praveen V. Mummaneni, Handbook of Neurosurgery, Neurology, and Spinal Medicine for Nurses and Advanced Practice Health Professionals, 2017
Assess the plantar reflex for the Babinski sign. Stroke the sole of the foot firmly. If present, the big toe will move upward and the other toes fan out. This reflex is only normal in children up to 2 years old. An abnormal finding can be indicative of a central nervous system problem.
Discussions (D)
Published in Terence R. Anthoney, Neuroanatomy and the Neurologic Exam, 2017
Authors of recent clinical neuroscience textbooks show a lot of variation and disagreement in their descriptions of how to test for presence of the Babinski sign. To begin with, should the stimulus be “sharp” or “blunt”? On the one hand, Barrows states that the stimulus “should be sharp” and that a common mistake is “failure to use a sharp stimulus” (1980, p. 83); whereas other authors state that the stimulus should be “blunt” (e.g., G&M, p. 57; MP&S, p. 64), should have “no sharp edges” (VanA&R, p. 62), or specifically that “A pin should not be used” (Bick, p. 195).
Reversible sub-acute motor neuron syndrome after mushroom intoxication masquerading as amyotrophic lateral sclerosis
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2022
Emmeline Lagrange, Elisa de la Cruz, Florence Esselin, Jean-Paul Vernoux, Nicolas Pageot, Guillaume Taieb, William Camu
In November 2015, his neurological state was similar, as were ALSFRS-r score, weight and SVC. He used a wheelchair on a regular basis. ALAT, GGT and CRP were normal at that time. By February 2016 he reported some improvement for walking, asthenia also improved and his weight raised at 98 kgs. ALSFRS-r score and SVC were still the same. Neurological examination showed bilateral Babinski sign with brisk tendon reflexes on the 4 limbs. Lower limb weakness was the same, with frequent falls and the patient used a wheelchair outside home only. There were fasciculations of the tongue and on the 4 limbs. He informed us that he had decided to stop eating mushrooms and seafood.
CAPN1 and hereditary spastic paraplegia: a novel variant in an Iranian family and overview of the genotype-phenotype correlation
Published in International Journal of Neuroscience, 2021
Mohammad Masoud Rahimi Bidgoli, Leila Javanparast, Mohammad Rohani, Hossein Najmabadi, Babak Zamani, Afagh Alavi
A literature review showed all patients who carried a mutation in CAPN1 manifest lower limb spasticity (clinical presentations were available for 40 cases) (Figure 5B and Table 1). The other frequently observed clinical features were lower limb hyperreflexia (28 cases; 70%), ataxia (24 cases; 60%), and dysarthria (21 cases; 52.5%). Babinski sign was positive in 19 cases and the other features consist of urinary dysfunction, weakness in lower limbs, skeletal deformity, visual/eye movements’ impairment, sensory/vibration abnormality, and cognitive impairment were not common among SPG76 patients (Figure 5B).
Transverse myelitis associated with primary biliary cirrhosis: clinical, laboratory, and neuroradiological features
Published in International Journal of Neuroscience, 2022
Mangsuo Zhao, Mingjie Zhang, Shimei Zhou, Bingxin Shi, Yan Wei, Fangjie Huang, Jing Wang, Jingfeng Huang, Liyan Qiao
On examination, no cognitive or cranial nerve disturbances were noted. Strength was 5/5 in the upper extremities. In the lower extremities, hip flexion was reduced to 3/5 and 4/5 on the right and left, respectively. Knee extension and flexion were intact bilaterally. The heel–knee–tibia test showed instability. Hypoesthesia to pinprick was noted below the level of T4, which was worse on the right than left side. Proprioception was intact bilaterally. Her deep tendon reflexes disappeared in the knees and ankles. Bilateral positive Babinski sign was noted.