Babinski reflex

バビンスキー反射

同

Babinski reflex sign

WordNet

1. an automatic instinctive unlearned reaction to a stimulus (同)reflex response, reflex action, instinctive reflex, innate reflex, inborn reflex, unconditioned_reflex, physiological reaction
2. extension upward of the toes when the sole of the foot is stroked firmly on the outer side from the heel to the front; normal in infants under the age of two years but a sign of brain or spinal cord injury in older persons (同)Babinski_reflex, Babinski_sign
3. (of leaves) bent downward and outward more than 90 degrees

PrepTutorEJDIC

1. 反射(刺激に対する無意識の反応) / 《複数形で》反射的な動き / (光などの)反射,反射光;映像 / 反射性の / (カメラが)レフ鋼の,反射型の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/09/23 03:58:35」(JST)

wiki en

[Wiki en表示]

The plantar reflex is a reflex elicited when the sole of the foot is stimulated with a blunt instrument. The reflex can take one of two forms. In normal adults the plantar reflex causes a downward response of the hallux (flexion). An upward response (extension) of the hallux is known as Koch sign, Babinski response or Babinski sign, named after Joseph Babinski (1857–1932), a French neurologist of Polish origin. The presence of the Babinski sign can identify disease of the spinal cord and brain in adults, and also exists as a primitive reflex in infants.

Methods

Pathological Babinski's sign in adult

The lateral side of the sole of the foot is rubbed with a blunt instrument or device so as not to cause pain, discomfort, or injury to the skin; the instrument is run from the heel along a curve to the toes (metatarsal pads). Many reflex hammers taper at the end of the handle to a point which was used for testing the plantar response in the past, however, due to the tightening of infection control regulation this is no longer recommended. Either a single use orange stick or the thumb nail should be used.

There are three responses possible:

• Flexor: the toes curve down and inwards, and the foot everts; this is the response seen in healthy adults.
• Indifferent: there is no response.
• Extensor: the hallux dorsiflexes, and the other toes fan out; this is Babinski's sign, which indicates damage to the central nervous system.

As the lesion responsible for the sign expands, so does the area from which the afferent Babinski response may be elicited. The Babinski response is also normal while asleep and after a long period of walking.

Interpretation

Babinski's Sign in a healthy newborn

The Babinski sign can indicate upper motor neuron lesion constituting damage to the corticospinal tract. Occasionally, a pathological plantar reflex is the first (and only) indication of a serious disease process and a clearly abnormal plantar reflex often prompts detailed neurological investigations, including CT scanning of the brain or MRI of the spine, as well as lumbar puncture for the study of cerebrospinal fluid.

Babinski sign is an up-turning or extensor plantar response. Modifiers "upgoing, "downgoing, "positive," or "negative" should not be applied. The phrase "negative Babinski sign" is a misnomer for a "flexor plantar response."

In infants

Main article: Primitive reflexes

Infants will also show an extensor response. A baby's smaller toes will fan out and his big toe will dorsiflex slowly. This happens because the corticospinal pathways that run from the brain down the spinal cord are not fully myelinated at this age, so the reflex is not inhibited by the cerebral cortex. The extensor response disappears and gives way to the flexor response around 12 to 24 months of age.

Pathways

Afferent: Nociception detected in the S1 dermatome and travels up the tibial nerve to the sciatic nerve to roots of L5,S1 and synapse in the anterior horn to elicit the motor response. Efferent: Motor response back through the L5,S1 roots to the sciatic nerve to its bifurcation. Toe flexors are innervated by the tibial nerve. Toe extensors (extensor hallicus longus, extensor digitorum longus) are innervated by the deep peroneal nerve. Loss of normal adult descending pyramidal control of the reflex arc to suppress extensor withdrawal results in the upgoing toes in the plantar reflex known as Babinski's sign. There is no such thing as a negative Babinski's sign.

Relationship to Hoffmann reflex

Main article: Hoffmann's reflex

The Hoffmann's reflex is sometimes described as the upper limb equivalent of the Babinski sign because both indicate upper motor neuron dysfunction. Mechanistically, they differ significantly; the finger flexor reflex is a simple monosynaptic spinal reflex involving the flexor digitorum profundus that is normally fully inhibited by upper motor neurons. The pathway producing the plantar response is more complicated, and is not monosynaptic. This difference has led some neurologists to reject strongly any analogies between the finger flexor reflex and the plantar response.^{[citation needed]}

Babinski-like responses

The plantar reflex can be elicited in a number of ways, which were described in the late 19th and early 20th century. These have their own eponyms.

Abnormal reflex seen as extension of the big toe

• Bing sign – multiple pinpricks on the dorsum of the foot
• Cornell sign – scratching along the inner side of the extensor hallucis longus tendon
• Chaddock sign – stroking the lateral malleolus
• Gonda sign – flexing and suddenly releasing the 4th toe
• Gordon sign – squeezing the calf muscle
• Moniz sign – forceful passive plantar flexion of the ankle
• Oppenheim sign – applying pressure to the medial side of the tibia
• Schaeffer sign – squeezing the Achilles tendon
• Stransky sign – vigorously abducting and suddenly releasing the little toe
• Strümpell sign – patient attempts to flex the knee against resistance
• Throckmorton reflex – percussion over the metatarsophalangeal joint of the big toe

Abnormal reflex seen as flexion of toes

• Bekhterev-Mendel reflex – flexion of the 2nd to 5th toes on percussion of the dorsum of the foot
• Rossolimo sign – exaggerated flexion of the toes induced by rapid percussion on the tips of the toes

References

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 成人における詳細な神経学的検査 the detailed neurologic examination in adults
• 2. 幼児および小児における精密な神経学的評価 detailed neurologic assessment of infants and children
• 3. 新生児の神経学的検査 neurological examination of the newborn
• 4. 救急外来における急性の筋力低下を訴える成人の評価 evaluation of the adult with acute weakness in the emergency department
• 5. 筋萎縮性側索硬化症およびその他の運動ニューロン疾患の診断 diagnosis of amyotrophic lateral sclerosis and other forms of motor neuron disease

English Journal

• The unbearable lightness of the extrapyramidal system.

• de Oliveira-Souza R, Tovar-Moll F.SourceD'Or Institute for Research & Education, Rio de Janeiro, Brazil.
• Journal of the history of the neurosciences.J Hist Neurosci.2012 Jul;21(3):280-92. doi: 10.1080/0964704X.2011.595652.
• The concept of the extrapyramidal system comprises an amalgam of disparate and often conflicting ideas with a tortuous history. To the theoretical neuroscientist or practicing clinician, it promptly evokes semantic associations that are hardly reminiscent of its original meaning. The purpose of this
• PMID 22724489

• Clinical trial of a method for confirming the effects of spinal anesthesia in patients with spinal cord injury.

• Takatsuki A, Ohtsuka M.SourceDepartment of Anesthesia, Kanagawa Rehabilitation Hospital, 516 Nanasawa, Atsugi, Kanagawa, 254-0121, Japan, takatuki@pp.iij4u.or.jp.
• Journal of anesthesia.J Anesth.2012 Jun 19. [Epub ahead of print]
• In this case series study, we prospectively examined whether it might be possible to check the effect of spinal anesthesia (SA), based on the disappearance of lower extremity reflexes and spasticity, in patients with spinal cord injury (SCI), in whom the effect cannot be confirmed by the pinprick te
• PMID 22706640

Japanese Journal

• 逆Chaddock徴候 (特集 日本人の発見した神経症候)

• 田代 邦雄
• Brain and nerve 63(8), 839-850, 2011-08
• NAID 40018943964

• Prevalence of Physical Signs in Cervical Myelopathy : A Prospective, Controlled Study

• RHEE John M.,HEFLIN John A.,HAMASAKI Takahiko,FREEDMAN Brett
• Spine 34(9), 890-895, 2009-04-20
• NAID 10027241142

Related Links

• Babinski's reflex: MedlinePlus Medical Encyclopedia

The presence of a Babinski's reflex after age 2 is a sign of damage to the nerve paths connecting the spinal cord and the brain (the corticospinal tract). This tract runs down both sides of the spinal cord. A Babinski's reflex can occur on one side ...

• Babinski Reflex - YouTube

17 Sep 2008 ... A video showing how the Babinski reflex is tested for in adults.

Related Pictures

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★リンクテーブル★

リンク元	「原始反射」「バビンスキー反射」「病的反射」
関連記事	「reflex」

「原始反射」

　　[★]

英

primitive reflex

関

反射

• 新生児期にみられ、中枢神経系の発達と共にやがて消失する反射
• 中枢神経系の発達の指標となる
• 原始反射の欠如は中枢神経系の障害を示す。
• 左右非対称性な原始反射は末梢性運動神経障害を示す。
• 原始反射消失の遅延は中枢性の運動神経の発達障害を意味する。

原始反射　(出典不明)

中枢	消失時期	反射
脊髄	～生後3ヶ月		magnet reflex
		歩行反射	stepping reflex
		把握反射	grasping reflex
		非対称性緊張性頚部反射	asymmetrical tonic neck reflex	背臥位にした新生児の頭を一方に向けると、顔の向いた方の上下肢は伸展し、後頭側の上下肢は屈曲する
脊髄-橋	～生後6ヶ月	モロー反射	Moro reflex	頭を持ち上げて急に落とす動作をした時に両上肢を開き、側方から正中方向に抱きつくような動き
		口唇探索反射	rooting reflex
		緊張性頚反射	tonic neck reflex	腹位水平抱きまたは座位で頚を背屈すると上肢が伸展、背筋が緊張し、頚を前屈すると上肢が屈曲し、体幹のトーヌスが減弱する
中脳	生後6ヶ月～5歳	立ち直り反射	righting reflex
		頚立ち直り反射
		体幹立ち直り反射
		視性立ち直り反射
大脳皮質 中脳	生後8ヶ月～終生	パラシュート反射		水平位にして、突然頭を下げると腕が伸びて身体を支えようとすること。

反射の消長

反射		出現	消失
モロー反射	Moro reflex	生来	3～4
口唇探索反射	rooting reflex	生来	4～7
吸啜反射	sucking reflex	生来	4～7
手指把握反射	palmar grasp reflex	生来	6
足底反射	plantar grasp reflex	生来	10
バビンスキー反射	Babinski reflex	生来	24
緊張性頚反射	tonic neck reflex	2	6
Landau反射	Landau reflex	3	24
パラシュート反射		9	一生

「バビンスキー反射」

　　[★]

英

Babinski's reflex (SP), Babinski reflex

同

バビンスキー徴候 Babinski sign、足指背屈型足底反射 dorsiflexor type of plantar reflex、バビンスキー現象、伸展性足底反射 extensor plantar reflex extensor plantar response

関

反射、運動麻痺、錐体路徴候

概念

• 乳幼児や錐体路障害を来した成人で見られ、足裏外側をなぞった際に起こる足指を反らしながら開く反射(足底刺激に対して母指が背屈する(PT.123))である。健常な人では母指が底屈する。乳幼児の場合、抑制系ニューロンの未発達により生じ、成人では上位運動ニューロンの障害により生じる。生後から見られおよそ1歳(8ヶ月～2歳)(G10M.339)で消失する。

国試

• 101D009

<youtube v=oI_ONptx2Ns></youtube>

-バビンスキー徴候

「病的反射」

　　[★]

英

pathologic reflex

• 正常成人では出現せず、錐体路(皮質脊髄路、上位運動ニューロン)が障害されたときに誘発される反射

病的反射 BET.80

• 吸引反射 sucking reflex：前頭葉の障害、両側大脳のびまん性な障害
• 口尖らし反射 snout reflex：両側錐体路障害
• 手指屈筋反射 finger flexion reflex：C6-Th1

• ホフマン反射 Hoffmann reflex
• トレムナー反射 Tromner reflex
• ワルテンベルク反射 Wartenberg reflex

• 把握反射 grasp reflex：前頭葉
• バビンスキー反射 Babinski reflex：L5-S1　→　L4,5
• チャドック反射 Chaddock reflex：L5-S1　→　L4,5

「reflex」

　　[★]

• n.

• 反射

関

reflect、reflection、reflective