A New Method of Eliciting Pyramidal Tract Impairment in Adults

Folia Med (Plovdiv). 2020 Mar 31;62(1):65-69. doi: 10.3897/folmed.62.e47768.

Abstract

Background: To suggest a new way of eliciting pyramidal tract dysfunction in adults since the most widely utilized plantar reflex, which is the Babinski reflex, has limitations with different reliability and consistency among different examiners.

Materials and methods: 168 adult subjects were examined for the new sign in addition. It consists of just an observation of the patient’s feet and toes in a conscious patient looking for the extension of the great toe along with fanning, spreading and plantar flexion of the small toes either at rest or when patient elevates one leg up at a time.

Results: We were able to observe the extension of the great toe along with fanning, spreading and plantar flexion of the small toes in patients with impairment of pyramidal tract. The specificity was 94% while the sensitivity was 96%.

Conclusion: Pyramidal tract lesion in adults can be elicited by this new test that observes the extension of the great toe along with fanning, spreading and plantar flexion of the small toes in patients. We suggest this sign as a complement to established signs like Babinski reflex.

Keywords: Babinski; Pasupuleti sign; extensor plantar response; pyramidal sign.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Infarction / physiopathology*
  • Case-Control Studies
  • Cerebral Small Vessel Diseases / physiopathology*
  • Female
  • Foot*
  • Humans
  • Male
  • Middle Aged
  • Multiple Sclerosis / physiopathology*
  • Neurologic Examination / methods*
  • Pyramidal Tracts / physiopathology*
  • Reflex, Babinski / physiology
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Toes*
  • Young Adult