What are the possible pathologic reflex findings on neurologic assessment for electrodiagnostic medicine?

Updated: Aug 06, 2019
  • Author: Brian M Kelly, DO; Chief Editor: Stephen Kishner, MD, MHA  more...
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Answer

Answer

The Babinski sign is the characteristic initial extension of the first metatarsal joint, often with fanning of the toes and ankle with dorsiflexion when the lateral edge of the sole of the foot is stroked from posterior to anterior and then across to the medial side under metatarsal heads (in patients with UMN lesions). Although this is the superficial plantar reflex, it is mentioned specifically because there are alternative methods of eliciting this reflex, including the following:

  • Oppenheim sign (noxious stimuli down the tibial crest)

  • Chaddock sign (noxious stimuli around the lateral malleolus in the shape of a C down to the lateral heel)

  • Bing sign (a noxious focal point of pressure on the extensor hallucis longus tendon at the metatarsal phalangeal joint)

All of the following methods elicit identical graded responses, depending on the degree and age of the UMN lesion.

  • Hoffman sign is elicited by a brief flexion flick that causes a quick extension of the distal interphalangeal joint of the middle finger, resulting in a flexion response of the thumb; in more pronounced reflexes, all of the fingers flex. The Hoffman sign generally is considered a sign of hyperreflexia, although it can be seen in normal patients. Hoffman sign usually is absent in unaffected patients and is present in patients with pyramidal tract lesions (similar significance to plantar response, but it is not a deep or superficial reflex).

  • Palmomental reflex (Radovici sign) is present in pyramidal tract lesions, frontal lobe lesions, and lesions causing increased intracerebral pressure. [17]

  • Frontal release signs suggest lesion in the frontal lobes (eg, glabellar, suckling and rooting, grasp).


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