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+Babinski sign of pyramidal dysfunction
In English please, what is a pyramidal dysfunction? I keep looking this up and can't find anything that tells me what it is?
Thanks
Suzanne
Thanks
Suzanne
Good, I want someone to explain why it is so hard for some doctors to actually do their jobs..They should always put their feelings last, and think of the patients first..I would rather a person feel like they can actually trust me..It makes a person really sit back and wonder how they make it in their profession..Honesty is always the best policy
I'll try to weigh in here. I'm fading fast.
The Pyramidal Tract is a group of neurons (cell bodies with their looooong nerve fibers) that begin all spread out in the cortex (outer edge) of the brain and come together in a couple of bundles, run into the brainstem where most of them cross to the other side, and then run down the spinal cord until they come to their exit.
Because the shape of all these fibers together forms an up-side-down pyramid, they are sometimes called the Pyramidal Tract and when there are signs of damage in them those are called pyramidal signs. The vast majority of the nerves in the pyramidal tract are motor neurons, so the signs of problems will be with the muscles, as opposed to the snesory nerves. Two other names for these are the "corticospinal tracts" and "upper motor neurons."
Signs that something is amiss could be weakness, spasticity, hyperreactive reflexes, +Babinski sign, + Hoffman's sign, etc.
The Babinski - This test is harder to perform and interpret than it looks. It takes lots (LOTS) of practice. It is supposed to be a "noxious stimulus" applied to the bottom of the ffot along the outside edge and then across under the toes. The doc looks for an initial flaring upward (may be very subtle) of the great toe. Sometimes all the toes will also flare out. Normal is an initial downward movement of the toe or sometimes no movement at all.
If the examiner does it too harshly, causing pain, the patient will withdraw the foot and the toes may go up (sometimes when the patient tries to pull away from the doc they will pull their toes up in the effort to get away from the discomfort. That's what 'Zilla was talking about with false positives) , BUT if the examiner is watching very closely and the Babinski is +, the toes will have already made a tiny motion upward. Conversely, if the examiner is harsh and causes pain, and the Babinski is "negative" there will be a brief downward motion, before the foot withdraws (Most examiners will hold the foot in place so that you can't withdraw it. Someone who is trying to fake a "positive" will invariably time it wrong and this will be obvious to the experienced doc.
If the doc leaves the socks on the fabric will blunt (soften) the noxiousness of the stimulus and may cause a "false negative." It is also rude. If the socks are very thin, the pointer may tear the socks. In the hands of a skilled examiner there should not be a false positive. That is also why they usually repeat the test 2 or more times.
Thester - you bring up a good point and I will try to talk about it soon.
Quix
The Pyramidal Tract is a group of neurons (cell bodies with their looooong nerve fibers) that begin all spread out in the cortex (outer edge) of the brain and come together in a couple of bundles, run into the brainstem where most of them cross to the other side, and then run down the spinal cord until they come to their exit.
Because the shape of all these fibers together forms an up-side-down pyramid, they are sometimes called the Pyramidal Tract and when there are signs of damage in them those are called pyramidal signs. The vast majority of the nerves in the pyramidal tract are motor neurons, so the signs of problems will be with the muscles, as opposed to the snesory nerves. Two other names for these are the "corticospinal tracts" and "upper motor neurons."
Signs that something is amiss could be weakness, spasticity, hyperreactive reflexes, +Babinski sign, + Hoffman's sign, etc.
The Babinski - This test is harder to perform and interpret than it looks. It takes lots (LOTS) of practice. It is supposed to be a "noxious stimulus" applied to the bottom of the ffot along the outside edge and then across under the toes. The doc looks for an initial flaring upward (may be very subtle) of the great toe. Sometimes all the toes will also flare out. Normal is an initial downward movement of the toe or sometimes no movement at all.
If the examiner does it too harshly, causing pain, the patient will withdraw the foot and the toes may go up (sometimes when the patient tries to pull away from the doc they will pull their toes up in the effort to get away from the discomfort. That's what 'Zilla was talking about with false positives) , BUT if the examiner is watching very closely and the Babinski is +, the toes will have already made a tiny motion upward. Conversely, if the examiner is harsh and causes pain, and the Babinski is "negative" there will be a brief downward motion, before the foot withdraws (Most examiners will hold the foot in place so that you can't withdraw it. Someone who is trying to fake a "positive" will invariably time it wrong and this will be obvious to the experienced doc.
If the doc leaves the socks on the fabric will blunt (soften) the noxiousness of the stimulus and may cause a "false negative." It is also rude. If the socks are very thin, the pointer may tear the socks. In the hands of a skilled examiner there should not be a false positive. That is also why they usually repeat the test 2 or more times.
Thester - you bring up a good point and I will try to talk about it soon.
Quix
I had two MRIs of my spine done, but he was against doing one of mybrain...Don' t ask me why, I guess if he were in our shoes, he would understand the importance of having these tests done...He really did not say much of anything about the MRI results, he is a man of little words, sort of..He gets into these conversations with words that have 20 or more letters and I am like, huh..I am in a Neuros office for a reason..Please use lamens terms...But I guess that is just him. I agree with the gown thing, I always start to squirm when I see the gown coming near me..I do not really think he is able to sit a 25 year old down and let her know what is really going on..I told my PCP that it seems like he is overly concerned at how I might take it..For instance when I saw him on November 6th, after he elicited the babinski reflex and noticed the poor muscle control..That he was unsure if it was Neurological..But when I go to my PCP's office a week later he states he received a letter from the Neuro and his NP..In the letter they both imply they are concerned it is MS..What is the deal with that?
Suzanne~
The only thing that I know about a "false positive" when it comes to Babinski is that sometimes if the doc is too aggressive, the patient may pull the foot away, and it may appear to be positive, which I do not fully understand. If anything, though, it would make more sense for there to be more "false negatives."
Sometimes, the great toe will go up and then down, and the doc will not notice. If it goes up at all, this is abnormal, or the Babinski reflex. (Often the other toes will "fan out" when the great toes points upward, as mine did, but not necessarily.)
I know you would rather not have this sign, and you are questioning whether you do actually or not. It can be a difficult test to administer for some docs. When you see the MSclinic doc, tell him or her that you had the reflex when you were tested before, and it concerns you. Make sure they test you for it. Like I said it's a small piece of a bigger puzzle, but it IS important. Bottom line: I don't think it's LIKELY to have a false positive.
Thester~ Sometimes if the practioner is not experienced, it is too hard to elicit the reflex through socks. Quix has said before that it's lazy and improper to do the test with socks on. I HATE those gowns! I think it's only fair that the doc should wear one, too. Or at least buy dinner first, know what I mean? LOL!
Take care, girls!
Zilla*
The only thing that I know about a "false positive" when it comes to Babinski is that sometimes if the doc is too aggressive, the patient may pull the foot away, and it may appear to be positive, which I do not fully understand. If anything, though, it would make more sense for there to be more "false negatives."
Sometimes, the great toe will go up and then down, and the doc will not notice. If it goes up at all, this is abnormal, or the Babinski reflex. (Often the other toes will "fan out" when the great toes points upward, as mine did, but not necessarily.)
I know you would rather not have this sign, and you are questioning whether you do actually or not. It can be a difficult test to administer for some docs. When you see the MSclinic doc, tell him or her that you had the reflex when you were tested before, and it concerns you. Make sure they test you for it. Like I said it's a small piece of a bigger puzzle, but it IS important. Bottom line: I don't think it's LIKELY to have a false positive.
Thester~ Sometimes if the practioner is not experienced, it is too hard to elicit the reflex through socks. Quix has said before that it's lazy and improper to do the test with socks on. I HATE those gowns! I think it's only fair that the doc should wear one, too. Or at least buy dinner first, know what I mean? LOL!
Take care, girls!
Zilla*
What is the importance of the sock being off with the Babinski Reflex..Not trying to be a smart butt, but the first time my Neuro tested I was lying down on his table with my socks off, lol and everything else other than those see through gowns, yuck..At this time he noticed I had a positive babinski..At my PCP appointment with my socks off he noticed one as well..But at my last appointment with my Neuro his NP did the test with my sock on..And I don't know if they got an abnormal reflex then or not..By the time I talked to them I was too emotional..
Me again.....
Grasping at straws here: is it possible to have a +Babinski and that it's a false positive?
Here's what I mean. The day that I went in for the vertigo, I was edgy. I am the politest person you'd ever meet, but I wasn't exactly kind when the dr. left the room. I was spouting off to my husband that the dr. was forcing a reaction out of me, he was some kind of sadist (enjoys being cruel to others), he was just practicing until he got the reaction he wanted.
Then he came back in and mentioned the need for followup to rule out MS or fibromyalgia. And so it began.
Can a Babinski be forced? A false positive?
Suzanne
Grasping at straws here: is it possible to have a +Babinski and that it's a false positive?
Here's what I mean. The day that I went in for the vertigo, I was edgy. I am the politest person you'd ever meet, but I wasn't exactly kind when the dr. left the room. I was spouting off to my husband that the dr. was forcing a reaction out of me, he was some kind of sadist (enjoys being cruel to others), he was just practicing until he got the reaction he wanted.
Then he came back in and mentioned the need for followup to rule out MS or fibromyalgia. And so it began.
Can a Babinski be forced? A false positive?
Suzanne
Sorry~ got a visitor while I was posting, and didn't see your post in between!
Yes, I saw your message about the car accident, too. It does fuzzy things a bit, but a good doctor will work through all that. Find one. If the MS clinic doesn't work out, keep searching. I'm not saying go to the ends of the earth to find someone that will diagnose you with MS. I'm saying find someone who will give you a GOOD examination -- with your socksOFF. Sheesh! as Quix would say.
If someone has found you to have Babinski's, do not let it go. Find out why.
Good luck at the clinic and let us know how it goes.
Zilla*
Yes, I saw your message about the car accident, too. It does fuzzy things a bit, but a good doctor will work through all that. Find one. If the MS clinic doesn't work out, keep searching. I'm not saying go to the ends of the earth to find someone that will diagnose you with MS. I'm saying find someone who will give you a GOOD examination -- with your socksOFF. Sheesh! as Quix would say.
If someone has found you to have Babinski's, do not let it go. Find out why.
Good luck at the clinic and let us know how it goes.
Zilla*
The way I understand it, Babinski response or reflex in adults (either you have it or you don't) is abnormal. I happen to have it. I suspect you two do, as well. It can be one- or both-sided.
It is a sign for whoever's paying attention that something is very wrong in the nerve pathways, most likely the pyramidal tract, or the bundle of nerves that transmits impulses that control voluntary movement. It originates in the cerebral cortex and descends through the spinal cord. I gather that it gets its name from being continuations of the pyramids of the medulla oblongata -- whatever that may mean....
Whatever the origin of its name, the significance of the reflex to me always seems somewhat sinister. I hate to use such a strong word, but I feel that way. It's a sign that there's some kink in the chain of communication.
I said it's a sign. A sign is something your doctor can see. Your neurologist is the one who generally can elicit the Babinski reflex or response if she/he is trying correctly. My last neuro did, but my internist could not. A sign is diffenet than a symptom, which is something the patient experiences, like dizziness, fatigue, or nausea.
So, if you have been told you have Babinski'sresponse by a physician, it is a very real sign more investigation needs to be done. I would say it is uncommon. Do not let it drop. In the context of MS, it is quite significant. MS is one of the primary causes of the reflex. Maybe I didn't say that well. If you have Babinski's, one of the first things a physician should want to rule out would be MS. Clearer?
I hope someone will correct anything I've gotten wrong here, or elaborate further if possible or necessary.
Take care and be well!
Zilla*
It is a sign for whoever's paying attention that something is very wrong in the nerve pathways, most likely the pyramidal tract, or the bundle of nerves that transmits impulses that control voluntary movement. It originates in the cerebral cortex and descends through the spinal cord. I gather that it gets its name from being continuations of the pyramids of the medulla oblongata -- whatever that may mean....
Whatever the origin of its name, the significance of the reflex to me always seems somewhat sinister. I hate to use such a strong word, but I feel that way. It's a sign that there's some kink in the chain of communication.
I said it's a sign. A sign is something your doctor can see. Your neurologist is the one who generally can elicit the Babinski reflex or response if she/he is trying correctly. My last neuro did, but my internist could not. A sign is diffenet than a symptom, which is something the patient experiences, like dizziness, fatigue, or nausea.
So, if you have been told you have Babinski'sresponse by a physician, it is a very real sign more investigation needs to be done. I would say it is uncommon. Do not let it drop. In the context of MS, it is quite significant. MS is one of the primary causes of the reflex. Maybe I didn't say that well. If you have Babinski's, one of the first things a physician should want to rule out would be MS. Clearer?
I hope someone will correct anything I've gotten wrong here, or elaborate further if possible or necessary.
Take care and be well!
Zilla*
Well....depends on who you talk to. (argh)
I had a vertigo issue on 12/24, in which the walk-in clinic dr. said I had hyperreflexia, +Babinski and Hoffmans. He suggested I go to my primary to get a referral to a neuro to rule out MS or fibromyalgia.
Last week my primary tested my feet (with socks ON vs. above with socks OFF) and he said he was not "impressed" with any brisk reflexes, to be careful not to self-diagnose. But at my insistence, he had the staff set up an appt. for me at the local neuro place. I had looked up any MS places here in CT and tada!! There is one only 10 minutes from me! I have an appt. with them next Wednesday!
Long answer, sorry, LOL. In summary, 1st dr. says I have these abnormal reflexes, but my pcp is not impressed, doesn't get the same response.
To add further to this "stuff", I remembered this AM that I had been in a car accident 20 years ago and I had been given a partial disability diagnoses related to spinal concerns.
I'm so complex it's giving me a complex.....LOL. :-/
Suzanne
I had a vertigo issue on 12/24, in which the walk-in clinic dr. said I had hyperreflexia, +Babinski and Hoffmans. He suggested I go to my primary to get a referral to a neuro to rule out MS or fibromyalgia.
Last week my primary tested my feet (with socks ON vs. above with socks OFF) and he said he was not "impressed" with any brisk reflexes, to be careful not to self-diagnose. But at my insistence, he had the staff set up an appt. for me at the local neuro place. I had looked up any MS places here in CT and tada!! There is one only 10 minutes from me! I have an appt. with them next Wednesday!
Long answer, sorry, LOL. In summary, 1st dr. says I have these abnormal reflexes, but my pcp is not impressed, doesn't get the same response.
To add further to this "stuff", I remembered this AM that I had been in a car accident 20 years ago and I had been given a partial disability diagnoses related to spinal concerns.
I'm so complex it's giving me a complex.....LOL. :-/
Suzanne
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