Babinski reflex

My dad is 76 yo diagnosed with bipolar disorder.  He has a history of alcohol and pill abuse and has been an active AA member for two years now.  He recently saw a neurologist for a tremor which was diagnosed as essential tremor.  He was started on inderal for this (he also takes lithium, wellbutrin and depakote).  During the neuro exam, he exhibited difficulties with short term memory and demonstrated some problem with coordination.  He also exhibited a positive babinski reflex.  The neurologist said best case scenario is a vitamin b12 deficiency (we haven't heard back on the blood tests, which makes me assume they came back without a problem) and listed a number of other possibilites (alzheimers, brain tumor, stroke).  My dad also has some minor leg weakness and neck pain.  He is having an MRI and a spect scan.  Are any of these scenarios more likely than the other?  Could it be cervical stenosis or something like that?  I guess I panicked when I read that the babinski reflex always means something in anyone over 2, so any other information would be much appreciated.  Thanks.

[CCF-Neuro-M.D.-PW]

A positive babinski sign, which is the 1st movement of the toe being upwards in stimulation of the sole of the foot, has a broad range of causes. I cannot tell you what the diagnosis is based on the information you provide. It could be cervical spondylosis and this is very common in the elderly. It is always abnormal, but whether it is just a age-related degenerative spine or a stroke I do not know. An MRI of the head and neck is a good way to go.
Good luck

[nosol]

Hello.

While it is true that Babinski reflex is an abnormal finding, it can also be relatively nonspecific.   In fact, a good neurologist can elicit a babinski reflex in just about anyone.  Having said that, however, your father may, in fact, have several reasons for the Babinski reflex to be present.  Some prior-alcohol related changes in the brain can lead to the presence of all of the above findings.  B12 deficiency is certainly a reasonable assumption.   However, in the absence of any "focal" findings,  a stroke or a tumor should not be high on the list.  

I would, however, make sure that your dad has an MRI of the neck before any sort of a PET scan, as in the presence of neck pain, it may explain both weakness in the legs and a Babinski reflex.  Cervical spondylosis is one of the most common findings in older people and should be taken seriously.  

Good luck!
ON