Review Question - QID 216546

This patient who presents with an upgoing big toe and fanning of the other toes has a positive Babinski sign. This sign would be positive in patients with stenosis of the cervical spine.

The Babinski sign is elicited by using an object to scrape the sole of the foot from the heel towards the toes. The toes go upwards during infancy, but this reflex should disappear by 2 years of age. In older children or adults, an upgoing big toe and fanning of the other toes is a positive Babinski sign that is suggestive of an upper motor neuron lesion. Common causes of a positive Babinski sign include cervical stenosis, spinal cord injury, multiple sclerosis, stroke, and amyotrophic lateral sclerosis.

Ambesh et al. present a comprehensive review of the Babinski sign and modern diagnostic modalities like video analysis and electromyography that may be used to increase its utility.

Incorrect Answers:
Answer 1: Cerebellum lesions would present with deficits in balance and gait. A classic physical exam finding for these lesions is the Romberg sign, in which patients lose balance after being asked to close their eyes while standing. Other findings include ataxia, abnormal rapid alternating movements, and an abnormal finger-nose-finger on exam.

Answer 3: Extensor hallucis longus muscle lesions can cause fixed contractures of the first metatarsal joint in patients with cerebral palsy. These lesions would present with a static deformity rather than a dynamic spasm of the muscle.

Answer 4: Lumbar nerve roots lesions at the L5 level can result in weakness of the lower extremity; however, patients will present with flaccid paralysis of the big toe extensors rather than overactive firing of these muscles.

Answer 5: Sciatic nerve lesions can also present with lower extremity weakness; however, the classic physical exam finding for this disorder is shooting pain below the knee with a straight leg raise.

Bullet Summary:
A positive Babinski sign is an upgoing big toe and fanning of the other toes with scraping of the sole and is indicative of an upper motor neuron lesion.