Accuracy of the Babinski sign in the identification of pyramidal tract dysfunction

Jaramillo, Sandra Patricia Isaza; Uribe, Carlos Santiago; Jimenez, Francisco A. García; Cornejo-Ochoa, William; Restrepo, Juan Felipe Álvarez; Román, Gustavo C.

doi:10.1016/j.jns.2014.05.028

Cited by 23 publications

(16 citation statements)

References 8 publications

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“…The Babinski result from our study is not very different from that found by Miller and Johnson 10 or Isaza Jaramillo et al 11 While previous studies on the plantar reflex provided information regarding the accuracy of the Babinski sign for acute PTD diagnosis, we additionally provide insight into the diagnostic value of the Chaddock and Oppenheim. The Babinski result from our study is not very different from that found by Miller and Johnson 10 or Isaza Jaramillo et al 11 While previous studies on the plantar reflex provided information regarding the accuracy of the Babinski sign for acute PTD diagnosis, we additionally provide insight into the diagnostic value of the Chaddock and Oppenheim.…”

Section: Sensitivity and Ppvsupporting

confidence: 48%

“…11 showed that the accuracy of the Babinski sign to diagnose PTD was similar to the area under a receiver operating characteristic curve, with a reliability of 0.73. 11 showed that the accuracy of the Babinski sign to diagnose PTD was similar to the area under a receiver operating characteristic curve, with a reliability of 0.73.…”

Section: Interobserver Agreementmentioning

confidence: 78%

“…Maher et al, 17 Isaza Jaramillo et al, 11 and Estañol et al 13 report higher intraobserver agreement for the Babinski (0.60, 0.57, and 0.98, respectively). These results do not differ greatly from the results of Singerman and Lee 6 (0.35 for the Babinski, 0.52 for the Chaddock, and 0.49 for the Oppenheim), even though we included 62 patients and Singerman and Lee included only 6 patients observed twice.…”

Section: Intraobserver Agreementmentioning

confidence: 95%

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The plantar reflex

Araújo

Firmino-Machado²,

Correia³

et al. 2015

Neur Clin Pract

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The utility of the plantar reflex in modern neurology is controversial. We studied the Babinski, Chaddock, and Oppenheim reflexes in terms of intraobserver, interobserver, and intertest agreement; sensitivity; positive predictive value (PPV); and observer bias. Sixty-two patients and 1,984 reflexes were analyzed. Intraobserver and interobserver agreement were weak (median κ <0.4). Intertest agreement was weak (median κ < 0.4) for all paired reflexes, although highest for the Babinski/Chaddock (0.30) ( < 0.05). There was no evidence of observer bias. Sensitivity was 59.7% for the Babinski, 55.3% for the Chaddock, and 30.0% for the Oppenheim. PPV was 70.3% for the Babinski, 66.5% for the Chaddock, and 61.3% for the Oppenheim. Our results show consistently low observer agreement for the plantar reflex. The Babinski and the Chaddock demonstrated comparable sensitivity and PPV.

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Section: Sensitivity and Ppvsupporting

confidence: 48%

Section: Interobserver Agreementmentioning

confidence: 78%

Section: Intraobserver Agreementmentioning

confidence: 95%

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The plantar reflex

Araújo

Firmino-Machado²,

Correia³

et al. 2015

Neur Clin Pract

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“…Interestingly, testing both for neck stiffness – after careful exclusion of preceding trauma – and the Babinski sign are highly recommended by our experts. This reflects the importance of using highly specific tests (Isaza Jaramillo et al., 2014; Nakao, Jafri, Shah, & Newman, 2014; van de Beek et al., 2004) that recognize conditions requiring prompt initiation of treatment (Auburtin et al., 2006; Möhlenbruch et al., 2014), although mixed results regarding the sensitivity of each sign have been reported (Isaza Jaramillo et al., 2014; Mattle et al., 2011). …”

Section: Discussionmentioning

confidence: 99%

“…Five of these steps pertain to the inspection of the patient (Steps specific cerebral dysfunction or unspecific extra-cerebral events as the potential underlying reasons for unconsciousness (Posner et al, 2007). Another important group of examination steps involving the brainstem (Steps 2,13,14,15,16,18,and 24) are particularly informative due to their excellent localization potential and adjacency to the arousal system (Fuller, 2013 This reflects the importance of using highly specific tests (Isaza Jaramillo et al, 2014;Nakao, Jafri, Shah, & Newman, 2014;van de Beek et al, 2004) that recognize conditions requiring prompt initiation of treatment (Auburtin et al, 2006;Möhlenbruch et al, 2014), although mixed results regarding the sensitivity of each sign have been reported (Isaza Jaramillo et al, 2014;Mattle et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

The essential neurological examination of the unconscious patient in the emergency room

2018

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ObjectiveTo determine whether neurologists with long‐term experience in the emergency room are in general agreement about the essential components of the neurological examination (NE) used on unconscious patients in whom an obvious cause for coma is lacking.MethodsWe surveyed 31 board‐certified practicing neurologists who regularly examine unconscious patients in the emergency room and asked them to list the specific components of the NE that they would normally choose to apply in at least 80% of cases.ResultsTwenty‐seven neurologists rated 24 of 38 items as essential steps of the neurological examination of the unconscious patient, with a high level of agreement amongst survey participants.ConclusionsThere was a high degree of consensus amongst the neurologists surveyed about which steps are essential for the NE of the unconscious patient. These findings provide an important source of validation for teaching this particular NE to medical students, as well as nonneurologists working in an emergency setting.

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Upper motor neuron signs in primary lateral sclerosis and hereditary spastic paraplegia

Santos Silva,

Correia Rodrigues,

Fortuna Baptista

et al. 2024

Muscle and Nerve

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Introduction/AimsThe frequency and distribution of upper motor neuron (UMN) signs in primary lateral sclerosis (PLS) are unknown. We aimed to study the spectrum of UMN signs in PLS and compare it with hereditary spastic paraplegia (HSP).MethodsWe retrospectively analyzed the frequency of different UMN signs, including hyperreflexia (limbs and jaw), limb and tongue spasticity, Babinski, and Hoffman signs, in PLS patients at first observation and compared this respect to onset region and symptom duration. We also compared PLS versus HSP patients.ResultsWe included 34 PLS and 20 HSP patients, with a median symptom duration at first visit of 3.0 (interquartile range, IQR = 4.0) and 19.0 (IQR = 22.0) years, respectively. In PLS patients, hyperreflexia of upper (UL) (88.2%) and lower (LL) (91.2%) limbs, and LL spasticity (79.4%) were the most common findings. Spasticity of LL was significantly (p = .012) more frequent in LL‐spinal onset subgroup, tongue spasticity in bulbar‐onset subgroup (p = .021), and Hoffman sign in UL‐spinal onset subgroup (p = .024). The PLS subgroup with shorter disease duration had a higher frequency of abnormal jaw jerk reflex (p = .037). Compared with HSP, PLS patients had a higher frequency of UL hyperreflexia (88.2% vs. 42.1%, p < .001) and UL spasticity (44.1% vs. 0.0%, p < .001). Asymmetric distribution of UMN signs was present in PLS and not in HSP.DiscussionIn PLS, UL UMN signs are nearly always present and UMN sign distribution appears to be associated with onset region. At first observation, bulbar involvement, asymmetrical distribution of UMN signs and UL spasticity may indicate PLS versus HSP.

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Accuracy of the Babinski sign in the identification of pyramidal tract dysfunction

Cited by 23 publications

References 8 publications

The plantar reflex

The plantar reflex

The essential neurological examination of the unconscious patient in the emergency room

Upper motor neuron signs in primary lateral sclerosis and hereditary spastic paraplegia

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