THE PLANTAR REFLEX - RePub

movements, but also the capacity to perform discrete and rapid movements
of the foot and great toe, as well as the activity of the flexion reflex
in other muscles than the extensor hallucis longus muscle alone. Neither
aspect has, to my knowledge, ever been studied quantitatively with the
object of establishing correlations with other pathological signs. Another
addition to the usual neurological examination was to look for associated
movements of the toes during voluntary efforts.
Four categories of patients were studied:
1) patients with a unilateral Babinski response (the main group)
2) patients who showed pyramidal signs but lacked a Babinski response
3) patients who changed from group 1 to 2 or vice versa
4) patients showing a paradoxical downward response of the great toe
after spinal transection.
Patients
METHODS
Within six months, 50 patients with a strictly unilateral and unequivocal
Babinski sign were found among in-patients and out-patients and were
included in the study. A restriction was that they should be well enough to
co-operate in the various tests and did not have unrelated motor deficits,
e.g. diseases of cerebellum, basal ganglia or peripheral nerves. They were
also followed up, when possible and relevant, and without consultation of
previous notes. A cerebral lesion was verified or supposed in 42 of the
patients. The diagnosis was infarction in 3 3, tumour in three, Mills' syndrome
in two (Mills, 1900), trauma in two, angioma in one, and infantile hemiplegia
in one; in 19 of these 42 patients the onset of disease had been less than four
weeks before the examination. The other eight patients had a (presumably)
spinal lesion: six were thought to have multiple sclerosis, one had an
old traumatic lesion, and one a recent infarction of the thoracic spinal cord.
A second group was formed in the same time span and from the same
population by six patients who unexpectedly lacked a Babinski sign,
without peripheral lesions to account for this. Four of these suffered from
cerebral infarction, one had motor neurone disease, and one had been
operated upon one year before because of an intracerebral haematoma.
A third group of five patients emerged from a follow-up study of
patients with an acute lesion from the two preceding cross-sectional
groups and hence overlaps with these. It included three patients who 'lost'
a unilateral Babinski response that had been present for some time (first
120