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Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
Question Title: Brisk vs. Hyper ReflexesForum: Neurology Forum
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I was told my reflex in my knees is a #4. I hear other people talk about brisk or hyper reflexes. What is the difference, and does a brisk or hyper relex always indicate a problem. What does a #4 reflex indicate and how is it determined. Thanks = Reflexes are usually graded on a scale of 0 to 4+. The "normal" is 2+, though in many cases I will accept 1+ (hyporeflexic, a bit less than expected) or 3+ (brisk, a bit more than expected) as normal. Typically if your reflexes are in the range of 1+ to 3+ and symmetric without any signs of localized damage to the nervous system (central or peripheral), you are doing OK. 4+ reflexes are very hyperactive. In general, hyperactive reflexes suggest diminished influence of descending control (from cells in the cerebral cortex). This could be a transient "normal" physiologic state, or it can reflect damage to that system from stroke, trauma, etc. Interpretation of reflexes in isolation from the history information and the full neurologic exam is unwise and fraught with errors. So it is not possible to tell you why your reflexes are 4+, or indeed, if the doctor was correct in assigning that grade as a result of his/her observation. I hope this helps. CCF MD mdf.
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