reflex abnormality

I was having headaches and my doctor sent me
to a nerologist because the were chronic. He
diagnosed me with tension headaches but said
he found that I had a bilateral babinski's
sign and I needed MRI's. I had one of the
cervical spine and it was normal. I am having
one of the brain this week. I researched the
reflex and even on this site I've seen that it
is always pathological. There seems to be
contraversy over this. All the neuro would
tell me is that I could have been injured
during birth. My regular doctor said that
sometimes they don't find anything especially
like in my case where the rest of the neuro
exam was normal. The headaches have even
resolved. I wanted to know what kind of injury
could cause this. I also wanted to know if it
could mean that I am going to develop a  
neurological disease later ( I am 33) or that
wouldn't be something that would show up
first. I was adopted and have only limited
info about my history. I do have a half sister
with CP.                    Thanks

[CCF Neuro[P] MD, RPS]

Dear Sarah:

The Babinski reflex can be difficult to elicit, especially for a non-neurologist.  This response can be mistaken for a withdrawal reflex.  If the reflex was indeed positive and real, then it indicates that there has been damage to the nerves that control the muscles in your legs.  This could have occurred when you were in utero.  I would wait for the MRI and see if there is anything on it.  My best guess it that it will be normal and the reflex was actually a withdrawal response.

Sincerely,

CCF Neuro MD

[Tara]

Dear Doctor,

I would like to ask you about a problem I have had.  I slowly lost my reflexes from lower to upper with 0 in arms and 0-trace in lower, including loss of gag reflex, which originally was 2++ in upper and 2++-1++ in lower.  I was diagnosed with mild myasthenia gravis just last month.  The doctors said that in order for me to loose my reflexes, I would have to have it pretty bad.  I also have numbness in lower legs and hands.  After my visit the other day, we found out my reflexes have come back.  They are more pronounced on the left side than the right.  I think I have the doctors puzzled with that one. I don't know if my gag reflex is back because they didnt check it. They said the mestinon would not make my reflexes come back.  But I don't understand what else could of made them come back besides the mestinon. In addition to the MG, I developed PVC's and Grover's disease.

I developed some cognitive problems after having a 3 day migraine which I believe was spawned by a very bad sinus infection.  I had severe tingling in my feet as well as pins and needles.  I also had an episode of not being able to urinate for about 5 hours after I woke up one day, that was within the week of the migraine, and just a list of bizarre symptoms after that.

They think something else is going on but are not sure, even though I thought they have ruled out MS, lupus, rheumatoid, etc they keep mentioning to watch and see what happens. There was nothing in my brain or spine scan that they did last summer.

Do you have any explanation possibly for the reflexes and are these normal symptoms to have with MG?

Thank you for any information you have to shed light on any of this.

[sarah]

Thanks for you quick answer. The reflex was found by a neurologist and he did repeat it several times. It was hurting my feet as he was repeating it. I was struck by lightening ten years ago. It entered my feet through legs & up spine. I was evaluated in ER and I was very lucky as it did not effect my heart. Could electric shock cause  a babinski by nerve damage? Someone once told me that lightening can leave subtle CNS changes.  
                       Thanks very much!

[CCF Neuro[P] MD, RPS]

Dear Sarah:

I guess then the positive Babinski is real.  To be expressed, there is usually a lesion in the lateral spinal tract or the projections of axons coming from the motor cortex in that tract.  As far as prognostication, I don't believe that there is any indication that if you have a Babinski, there is a progression of neuronal damage.  This would be especially true in your case.

Sincerely,

CCF Neuro MD

[Tara]

     Dear Doctor,

     I would like to ask you about a problem I have had. I slowly lost my reflexes from lower to upper with 0 in arms
     and 0-trace in lower, including loss of gag reflex, which originally was 2++ in upper and 2++-1++ in lower. I was
     diagnosed with mild myasthenia gravis just last month. The doctors said that in order for me to loose my reflexes, I
     would have to have it pretty bad. I also have numbness in lower legs and hands. After my visit the other day, we
     found out my reflexes have come back. They are more pronounced on the left side than the right. I think I have the
     doctors puzzled with that one. I don't know if my gag reflex is back because they didnt check it. They said the
     mestinon would not make my reflexes come back. But I don't understand what else could of made them come back
     besides the mestinon. In addition to the MG, I developed PVC's and Grover's disease.

     I developed some cognitive problems after having a 3 day migraine which I believe was spawned by a very bad
     sinus infection. I had severe tingling in my feet as well as pins and needles. I also had an episode of not being able to
     urinate for about 5 hours after I woke up one day, that was within the week of the migraine, and just a list of bizarre
     symptoms after that.

     They think something else is going on but are not sure, even though I thought they have ruled out MS, lupus,
     rheumatoid, etc they keep mentioning to watch and see what happens. There was nothing in my brain or spine scan
     that they did last summer.

     Do you have any explanation possibly for the reflexes and are these normal symptoms to have with MG?

     Thank you for any information you have to shed light on any of this.

[sarah]

Thanks again. I have a last question as I was unclear about one part of your answer. Were you saying that the babinski was probably real because the neurologist repeated it or because of the lightening or both. I ask because I should probably make sure the neurologist knows about the incident as he may not have seen it
on my record. An MRI would probably not be able to pick up problems in projections of axons? I would like to thank you and this site for taking the time to explain this.

[CCF Neuro[P] MD, RPS]

Dear Sarah:

The neurologist should be able to find a true Babinski.  No, a MRI should be able to pick up any lesion that your give you a positive Babinski (up to a limit of detection of course).  One would look at both the brain and spinal cord.  I am not sure if your insurance would cover this.

CCF Neuro MD

[Tara]

Dear Doctor,

     I would like to ask you about a problem I have had. I slowly lost my reflexes from lower to upper with 0 in arms
     and 0-trace in lower, including loss of gag reflex, which originally was 2++ in upper and 2++-1++ in lower. I was
     diagnosed with mild myasthenia gravis just last month. The doctors said that in order for me to loose my reflexes, I
     would have to have it pretty bad. I also have numbness in lower legs and hands. After my visit the other day, we
     found out my reflexes have come back. They are more pronounced on the left side than the right. I think I have the
     doctors puzzled with that one. I don't know if my gag reflex is back because they didnt check it. They said the
     mestinon would not make my reflexes come back. But I don't understand what else could of made them come back
     besides the mestinon. In addition to the MG, I developed PVC's and Grover's disease.

     I developed some cognitive problems after having a 3 day migraine which I believe was spawned by a very bad
     sinus infection. I had severe tingling in my feet as well as pins and needles. I also had an episode of not being able to
     urinate for about 5 hours after I woke up one day, that was within the week of the migraine, and just a list of bizarre
     symptoms after that.

     They think something else is going on but are not sure, even though I thought they have ruled out MS, lupus,
     rheumatoid, etc they keep mentioning to watch and see what happens. There was nothing in my brain or spine scan
     that they did last summer.

     Do you have any explanation possibly for the reflexes and are these normal symptoms to have with MG?

[sarah]

Hopefully I won't have any insurance coverage problems. The cervical spine I had was covered.
I assume the brain will be too since the neurologist insists it is necessary. This babinski reflex is obviously very significant
and a cause for concern. But now I understand why a little better. Thanks. I have the brain MRI in a couple of days. Maybe I'll post if the results are interesting or will help someone else.  

[CCF Neuro[P] MD, RPS]

Dear Tara:

Sorry to hear about your MG.  The tendon reflex need nerve transmission to work.  As you know, in MG the neurotransmitter is blocked from the receptor by specific antibodies.  When then receptors are blocked, we see muscle weakness.  When the muscle weakness if pronounce, we loose the deep tendon reflexes.  Mestinon would allow the muscle strength to return, which would thereby allow the deep tendon reflex to return.

CCF Neuro MD

[Tara]

Dear Doctor,

Thank you for letting me know that.  I spoke with the doctor today who told me that the mestinon could not of started my reflexes back because if you loose them it would of showed up on the single fiber emg, and some other stuff I didn't understand.  He said he didn't know why they were gone or why they came back but is glad they are back. So now I feel that they think I imagined it.  All I konw on the single fiber emg is there were blockages and jitter in 2 of the 4 muscles tested and jitter in the other two.  They have now scheduled me for a mri of my brain, they just did one in Sept. and they want me to have neuropsychological testing done.  Could you explain to me what the advantages are for this testing?  How will this change how the doctor is treating me?

[CCF Neuro[P] MD, RPS]

Dear Tara:

I think you need to ask your physician the question.  I can't answer a why question such as you ask.

CCF Neuro MD