Statistical Control Studies in neurology

Abstract

In view of the rather meager body of data concerning the incidence of the Oppenheim sign, two large groups, one of patients and one of healthy people, were studied to determine the frequency and significance of this sign.Oppenheim 1 described the sign in 1902. The technique employed by him consisted of vigorous stroking of the inner aspect of the leg along the posterior edge of the tibia with the handle of the percussion hammer, beginning just below the knee and ending at the ankle. In healthy people no movement or a plantar flexion of the big toe, and sometimes of all the toes, was produced. In affections of the pyramidal tract there was dorsiflexion of the big toe and sometimes of all the toes. Oppenheim examined 76 patients with neurasthenia, hysteria, hemicrania, tic convulsif, and similar affections. No dorsiflexion of the big toe was demonstrated. In only two instances, in which all other signs of lesions within the nervous system were lacking, was there a spread of the toes. Of the 574 people ex¬ amined by Pfeifer,2 200 were adults and 64 children with no nervous disorders. Ex¬ cept for six cases in the adult group with no nervous disorders in which dor¬ siflexion of the big toe and plantar flexion of the remaining toes occurred inconstantly and so quickly that a volitional element was present, no convincing Oppenheim sign was demonstrated. Of the 40 children up to one year of as;e, the Oppenheim sign was pres¬ ent in 35% and the Babinski sign in 62%.Of the 24 children from 1 to 12 years of Received for publication Feb. 25, 1956. From the Neuropsychiatric Service of the Morrisania City Hospital. age, S had the Babinski sign ; the Oppen¬ heim sign was present in 3, once bilaterally and twice unilaterally. Cassirer 3 examined 185 patients ; 79 had functional nervous dis¬ orders. In the test for the Oppenheim sign, 65.8% of the 79 patients showed plantar flexion and in 34.2% plantar flexion was absent or movements of the toes were un¬ clear. No Oppenheim sign was present. Cassirer indicated that the Oppenheim sign was less constant than the Babinski sign. He agreed with Oppenheim that the Oppen¬ heim sign is more frequent in spastic conditions, and he also stated that it may appear before the Babinski sign. Schlesinger 4 examined 640 adults over 60 years of age ; the Oppenheim sign was present as frequently as the Babinski but was not found in all instances in which the Babinski sign was elicited. He considered it a val¬ uable sign. Deutsch 5 examined 500 healthy children between 6 and 14 years of age. Of