Doctors Lounge - Neurology Answers
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Forum Name: Neurology Topics
|thester6474 - Sun Jan 06, 2008 10:03 pm||
I went and saw my PCP thursday, I see him every two weeks, since he has me on medical leave..I think he is awesome, and wish that all physicians were as caring and sympathetic as he is...Thursday he decided to check my reflexes again...He noticed in one of my knees I had hyperreflexia, in the other I believe he said hyporeflexia..When checking the reflexes of my elbow, he noticed that one hand moved slightly (the thumb did not), and the other one did not. He also noted an abnormal Babinski Reflex in my right leg only...Thursday he also took something and stuck me several times, he wanted me to nod when I felt it...In some areas I couldn't feel it at all, he actually had to tell me when he was sticking me (he said he was stabbing it against my skin), in other areas I barely felt it, and in others I clearly felt it...He said that it was definetly lateralized...I do not know exactly what he meant by that, but like I said I truly respect this doc, he is awesome...What does he mean that it was lateralized, and which side of my spine or brain would you feel would be most affected (considering the babinski reflex is on my right side)? What conditions could cause this? He has now stated that he wants me to go further for diagnosis and treatment..He wants me to see a group of Neurologists at either Duke or Emory, both of which are hours and hours away...He must really think that it is serious...I have some reservations about traveling so far, because I would really like to keep the Neuro I have now..He is very compassionate and caring, which is important to a patient when they are in a time of our despair. The only way I want to go is if my current Neuro will work with the Neuros I see at Emory, I would really hate to lose him.. I am so ready to return to work, but my PCP says that he does not think that I am ready to go back, and I whole heartedly agree...I really need to know what is going on with me..on top of the problems I already have.I also have this burning sensation in my chest that has been extreme lately along with a tingling feeling in my head...What does all of this add up to? Could it really be Neurological, and if so what tests would you advise me to ask my Neuro to run?
My questions again are:
What does he mean that it was lateralized, and which side of my spine or brain would you feel would be most affected (considering the babinski reflex is on my right side only)?
What conditions could cause this?
What do all of these different signs implicate?
Could it really be Neurological, and if so what tests would you advise me to ask my Neuro to run?
|Dr. Chan Lowe - Sat Feb 02, 2008 2:18 am||
Hello Ms. Hester,
The babinki reflex occurs when the sole of the foot is scratched along the outside edge and across the ball of the foot. It causes the big toe to go upward and the other toes to fan out. It is a "primative" reflex meaning it is normally present in babies but subsequently "goes away". The reason it goes away is because the higher brain areas (the central nervous system or CNS) takes over and suppresses the reflex. If it didn't it would be nearly impossible to walk.
If it re-emerges, as in your case, it is an indication that something is causing a blockage of the suppression signal from the CNS allowing it to occur. The area of this can vary in actual location but a "positive" babinski reflex indicates a problem with the pyramidal tract (also known as the corticospinal tract).
Lateralization means that the problem is occurring only on one side of the body.
There are several things that could be causing these symptoms, including something pressing on the corticospinal tract at some point in the spinal cord or lower brainstem area.
Similar to the normal suppression of the babinski reflex, the deep tendon reflexes are usually suppressed some as well. When they become hyperreflexive it is a sign that something is impeding the normal suppression signal.
Hypotonocity may be due to several issues as well but commonly is simply that the reflex wasn't quite being triggered fully, often due to not hitting the reflex in just the right spot.
I would agree with your doctor that this needs to be evaluated further. You may need some imaging studies (such as an MRI) to help evaluate for problems.
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