Babinski reflex and the CUT reflex - a comparative study

The Babinski reflex and the CUT reflex were examined in 150 neurological patients and 20 controls. A positive CUT reflex occurred more frequently than a positive Babinski reflex in the patient material as a whole, and in different diagnostic groups. However, there was a low grade of correspondence between a positive CUT reflex and a positive Babinski reflex. There were many positive CUT reflexes in the group of normal persons. In a number of cases the examination of the CUT reflex was impossible because of lack of strength or incooperability. The study indicates that the CUT reflex and the Babinski reflex are not comparable phenomena.     

Kinaesthetic ipsilateral and crossed extensor plantar response: A new way to elicit upgoing toe sign (Babinski response)?

We describe a phenomenon of “kinaesthetic extensor plantar response” in advanced pyramidal dysfunction, an interesting observation noted in a patient with dorsal myelopathy. A 44-year-old woman presented with one-year history of gradually progressive weakness and stiffness of both lower limbs along with urge incontinence of urine. Examination showed spontaneous elicitation of extensor plantar response while assessing the tone by rolling method as well as on noxious stimulation of the thigh. Magnetic resonance imaging (MRI) of the dorsal spine and digital subtraction angiography showed the presence of spinal dural arteriovenous fistula causing myelopathy. This case exemplifies the fact that in advanced pyramidal dysfunction, not only the receptive field of Babinski reflex may extend to the leg or thigh, but may also integrate with other modalities of stimulation, such as the rolling movement. The possible underlying pathophysiology of such a phenomenon is discussed.     

Consistency of the Babinski reflex and its variants

Background and purpose:  The Babinski Reflex, first described in 1896, is still an integral part of the neurological examination. Many have studied the consistency of this reflex, but none have compared the inter- and intra-observer consistency of the Babinski reflex and its variants.
Methods:  Thirty-four subjects were examined by six neurologists. The Babinski, Gordon, Chaddock, and Oppenheim reflexes were tested, and each neurologist concluded if the plantar response was flexor or extensor. Six subjects were re-tested 1 week later to determine intra-observer consistency.
Results:  The Babinski reflex had the highest interobserver consistency with a kappa value of 0.5491. The Chaddock, Oppenheim, and Gordon reflexes had kappa values of 0.4065, 0.3739, and 0.3515, respectively. For intra-observer consistency, Gordon was the most consistent with a kappa value of 0.6731. When reflexes were combined in pairs, the Babinski and Chaddock reflexes together were the most reliable.
Conclusions:  The Babinski reflex was shown to be the most consistent between examiners. The Gordon reflex had the highest intra-observer consistency; however, the small sample size should limit conclusions drawn from this calculation. Clinicians often utilize more than one reflex to examine the plantar response; the combination of the Babinski and Chaddock reflexes was the most reliable.     

Anton–Babinski syndrome in an old patient: a case report and literature review

Anton–Babinski syndrome is a rare disease featuring bilateral cortical blindness and anosognosia with visual confabulation, but without dementia or any memory impairment. It has a unique neuropsychiatric presentation and should be highly suspected in those with odd visual loss and imaging evidence of occipital lobe injury. In the case discussed herein, a 90‐year‐old man presented with bilateral blindness, obvious anosognosia, and vivid visual confabulation, which he had had for 3 days. Brain computed tomography demonstrated recent hypodense infarctions at the bilateral occipital lobes. Thus, the patient was diagnosed with Anton–Babinski syndrome. Because of his age and the thrombolytic therapy during the golden 3 hours after ischemic stroke, the patient received aspirin therapy rather than tissue plasminogen activator or warfarin. He gradually realized he was blind during the following week, but died of pneumonia 1 month later. In the literature, it is difficult to establish awareness of blindness in patients with Anton–Babinski syndrome, but optimistically, in one report, a patient was aware of blindness within 2 weeks, without vision improvement. Our case illustrates that elderly patients with Anton‐Babinski syndrome can partially recover and that 1 week is the shortest time for the establishment of awareness of blindness for sufferers without vision improvement.     

Myosin light and heavy chains in muscle regenerating in absence of the nerve: Transient appearance of the embryonic light chain

We examined myosin of fast and slow skeletal rat muscles regenerating after ischemia and bupivacaine injection in denervated limbs. Four days after injury two-dimensional gel electrophoresis revealed the presence of the embryonic light chain in the myosin isolated from the portion of muscle showing a homogeneous population of new small fibers by histological examination. Two weeks after injury this subunit was absent, whereas the two light chains, LC1F and LC2F, became prominent. One month after injury the still denervated soleus muscle maintained this light chain pattern. Gel electrophoresis in native condition of the myosin and peptide mapping of electrophoretically purified heavy chains confirmed that the muscle regenerating in absence of the nerve accumulated a myosin that had the general features of a fast, not slow, myosin but contained definite differences from the former.     

Making psychiatric semiology great again: A semiologic,not nosologic challenge

This article analyzes whether psychiatric disorders can be considered different from non-psychiatric disorders on a nosologic or semiologic point of view. The supposed difference between psychiatric and non-psychiatric disorders relates to the fact that the individuation of psychiatric disorders seems more complex than for non-psychiatric disorders. This individuation process can be related to nosologic and semiologic considerations. The first part of the article analyzes whether the ways of constructing classifications of psychiatric disorders are different than for non-psychiatric disorders. The ways of establishing the boundaries between the normal and the pathologic, and of classifying the signs and symptoms in different categories of disorder, are analyzed. Rather than highlighting the specificity of psychiatric disorders, nosologic investigation reveals conceptual notions that apply to the entire field of medicine when we seek to establish the boundaries between the normal and the pathologic and between different disorders. Psychiatry is thus very important in medicine because it exemplifies the inherent problem of the construction of cognitive schemes imposed on clinical and scientific medical information to delineate a classification of disorders and increase its comprehensibility and utility. The second part of this article assesses whether the clinical manifestations of psychiatric disorders (semiology) are specific to the point that they are entities that are different from non-psychiatric disorders. The attribution of clinical manifestations in the different classifications (Research Diagnostic Criteria, Diagnostic Statistic Manual, Research Domain Criteria) is analyzed. Then the two principal models on signs and symptoms, i.e. the latent variable model and the causal network model, are assessed. Unlike nosologic investigation, semiologic analysis is able to reveal specific psychiatric features in a patient. The challenge, therefore, is to better define and classify signs and symptoms in psychiatry based on a dual and mutually interactive biological and psychological perspective, and to incorporate semiologic psychiatry into an integrative, multilevel and multisystem brain and cognitive approach.     

False allegations of satanic abuse: Case studies from the witch panic in Rättvik 1670–71

The creation of false memories, psychiatric symptoms and false allegations of satanic child abuse during an outbreak of witch hysteria in Sweden in the seventeenth century are described and related to contemporary issues in child testimonies. Case studies of 28 children and 14 adults are presented. The mechanisms underlying the spread of these allegations, as well as the reactions and influence of the adult world on the children's testimonies, are discussed.     

Irradiation to the young mouse brain caused long-term,progressive depletion of neurogenesis but did not disrupt the neurovascular niche

We investigated the effects of ionizing radiation on microvessel structure and complexity in the hippocampus. We also assessed neurogenesis and the neurovascular niche. Postnatal day 14 male C57BL/6 mice received a single dose of 8 Gy to the whole brain and were killed 6 hours, 1 week, 7 weeks, or 1 year later. Irradiation decreased the total number of microvessels and branching points from 1 week onwards and decreased the total microvessel area 1 and 7 weeks after irradiation. After an initial increase in vascular parameter densities, concomitant with reduced growth of the hippocampus, the densities normalized with time, presumably adapting to the needs of the surrounding nonvascular tissue. Irradiation decreased the number of neural stem and progenitor cells in the hippocampus. The relative loss increased with time, resulting in almost completely ablated neurogenesis (DCX⁺ cells) 1 year after irradiation (77% decreased 1 week, 86% decreased 7 weeks, and 98% decreased 1 year after irradiation compared with controls). After irradiation, the distance between undifferentiated stem cells and microvessels was unaffected, and very few dying endothelial cells were detected. Taken together, these results indicate that the vasculature adjusts to the surrounding neural and glial tissue after irradiation, not vice-versa.     

Two magneto-encephalographic epileptic foci did not coincide with the electrocorticographic ictal onset zone in a patient with temporal lobe epilepsy

Abstract

To evaluate the usefulness and limitations of magneto-encephalography (MEG) for epilepsy surgery, we compared 'interictal' epileptic spike fields on MEG with ictal electrocorticography (ECoG) using invasive chronic subdural electrodes in a patient with intractable medial temporal lobe epilepsy (MTLE) associated with vitamin K deficiency intracerebral hemorrhage. A 19-year-old male with an 8-year history of refractory complex partial seizures, secondarily generalized, and right hemispheric atrophy and porencephaly in the right frontal lobe on MRI, was studied with MEG to define the interictal paroxysmal sources based on the single-dipole model. This was followed by invasive ECoG monitoring to delineate the epileptogenic zone. MEG demonstrated two paroxysmal foci, one each on the right lateral temporal and frontal lobes. Ictal ECoG recordings revealed an ictal onset zone on the right medial temporal lobe, which was different from that defined by MEG. Anterior temporal lobectomy with hippocampectomy was performed and the patient has been seizure free for two years. Our results indicate that interictal MEG does not always define the epileptogenic zone in patients with MTLE. [Neurol Res 2001; 23: 830-834]     

Axon degeneration: make the Schwann cell great again

Axonal degeneration is a pivotal feature of many neurodegenerative conditions and substantially accounts for neurological morbidity. A widely used experimental model to study the mechanisms of axonal degeneration is Wallerian degeneration(WD), which occurs after acute axonal injury. In the peripheral nervous system(PNS), WD is characterized by swift dismantling and clearance of injured axons with their myelin sheaths. This is a prerequisite for successful axonal regeneration. In the central nervous system(CNS), WD is much slower, which significantly contributes to failed axonal regeneration. Although it is well-documented that Schwann cells(SCs) have a critical role in the regenerative potential of the PNS, to date we have only scarce knowledge as to how SCs ‘sense' axonal injury and immediately respond to it. In this regard, it remains unknown as to whether SCs play the role of a passive bystander or an active director during the execution of the highly orchestrated disintegration program of axons. Older reports, together with more recent studies, suggest that SCs mount dynamic injury responses minutes after axonal injury, long before axonal breakdown occurs. The swift SC response to axonal injury could play either a pro-degenerative role, or alternatively a supportive role, to the integrity of distressed axons that have not yet committed to degenerate. Indeed, supporting the latter concept, recent findings in a chronic PNS neurodegeneration model indicate that deactivation of a key molecule promoting SC injury responses exacerbates axonal loss. If this holds true in a broader spectrum of conditions, it may provide the grounds for the development of new glia-centric therapeutic approaches to counteract axonal loss.     

One of the giants of neurological surgery left us more than a decade ago, and neurosurgical literature did not show much interest

One of the giants of neurological surgery left us over a decade ago. Charles George Drake died September 15, 1998 in London, Ontario after an extended bout with lung cancer. Although he will always be identified with taking posterior fossa aneurysm surgery from the realm of the daring to the domain of the routine, his contributions were much broader. Clinical neurosciences have been blessed in the past century by the life and works of Drake. In the neurosurgical world, the achievements of Drake are very well known and have been well recorded. Unfortunately, in the past decade since his passing, only one paper has been published about him and his contributions to neurosurgery. This is a historical paper regarding Charles George Drake that attempts to (1) remember Drake as a pioneer; (2) to evaluate lessons that we have learned from him; and (3) to address the question ‘What made him great?’. As per Drake's teachings, this paper is meant to articulate the unique perspectives Charlie provided with respect to how we learn our craft, maintain the integrity of reporting, and implement suggestions as to how we may progress into the future. In conclusion, it is our hope that this paper will bring to life the unique character of Drake and his unprecedented blend of genius, creativity, technical skill, introspection, and ever-present humility for all international neurosurgeons to appreciate.     

Fatty infiltration of the cervical extensor musculature,cervical sagittal balance,and clinical outcomes: An analysis of operative adult cervical deformity patients

PurposeTo assess preliminary associations between fatty-infiltration (FI) of cervical spine extensor musculature, cervical sagittal balance, and clinical outcomes in cervical deformity (CD) patients.MethodsOperative CD patients (C2-C7 Cobb > 10°, CL > 10°, cSVA > 4 cm, or CBVA > 25°) with pre-operative (BL) MRIs and 1-year (1Y) post-operative MRIs or CTs were assessed for fatty-infiltration of cervical extensor musculature, using dedicated imaging software at each C2-C7 intervertebral level and the apex of deformity (apex). FI was gauged as a ratio of fat-free-muscle-cross-sectional-area (FCSA) over total-muscle-CSA (TCSA), with lower ratio values indicating greater FI. BL-1Y associations between FI, sagittal alignment, and clinical outcomes were assessed using appropriate parametric and non-parametric tests.Results22 patients were included (Age 59.22, 71.4%F, BMI 29.2, CCI:0.75, Frailty: 0.43). BL deformity presentation: TS-CL: 29.0°, C2-C7 Sagittal Cobb:-1.6°, cSVA:30.4 mm. No correlations were observed between BL fatty-infiltration, sagittal alignment, frailty, or clinical outcomes (p > 0.05). Following surgical correction, C2-C7 (BL: 0.59 vs 1Y:0.67, p = 0.005) and apex (BL: 0.59 vs. 1Y: 0.66, p = 0.33) fatty-infiltration decreased. Achievement of lordotic curvature correlated with C2-C7 fatty infiltration reduction (R_s: 0.495, p < 0.05), and patients with residual postoperative TS-CL and cSVA malalignment were associated with greater apex fatty-infiltration (R_s: −0.565, −0.561; p < 0.05). C2-C7 FI improvement was associated with NRS back pain reduction (R_s: −0.630, p < 0.05), and greater apex fatty-infiltration at BL was associated with minor perioperative complication occurrence (R_s: 0.551, p = 0.014).ConclusionsDeformity correction and sagittal balance appear to influence the reestablishment of cervical muscle tone from C2-C7 and reduction of back pain for severely frail CD patients. This analysis helps to understand cervical extensor musculature’s role amongst CD patients.     

Androgen receptor immunoreactivity in skeletal muscle: enrichment at the neuromuscular junction

Potential cellular targets of androgen action within skeletal muscle of the rat were determined by comparing the cellular distribution of androgen receptor (AR)-positive nuclei in the highly androgen-responsive levator ani (LA) muscle with that of the relatively androgen-unresponsive extensor digitorum longus (EDL) muscle. We found that androgen responsiveness correlates with AR expression in muscle fibers and not in fibroblasts. Results indicate that a much higher percentage of myonuclei in the LA are AR(+) than in the EDL (74% vs. 7%), correlating with differences in androgen responsiveness. Both muscles contain an equivalent proportion of AR(+) fibroblasts (approximately 62%). AR(+) nuclei were not observed in terminal Schwann cells in either muscle. These results suggest that ARs within LA muscle fibers mediate the androgen-dependent survival and growth of the LA muscle and its motoneurons. We also observed an unexpected enrichment of AR(+) myonuclei and fibroblasts proximate to neuromuscular junctions, suggesting that ARs at muscle synapses may selectively regulate synapse-specific genes important for the survival and growth of motoneurons. Although castration reduced the proportion of AR(+) fibroblasts in both muscles, the proportion of AR(+) myonuclei was reduced only in the LA. As expected, testosterone treatment prevented these effects of castration but, unexpectedly, increased the proportion of AR(+) myonuclei in the EDL to above normal. These results suggest that how AR expression in skeletal muscle is influenced by androgens depends not only on the particular muscle but on the particular cell type within that muscle.     

The great gate: control of sensory information flow to the cerebellum

An evident feature of the physiology of the inferior olivary nucleus is modulation of the responsiveness of neurons to peripheral stimulation by the behavioral state of the subject animal. The olivary response to self-generated sensory inputs, as well as to input predictable from association with other stimuli, is suppressed. This suppression occurs in part at the level of the inferior olivary nucleus itself. On the other hand, the cells respond readily to sensory inputs that are not anticipated. On a cellular level inferior olivary neurons exhibit two properties that might account for information gating. The first one is the organization of synaptic inputs on olivary spines in glomerular structures, where extrinsic inhibitory and excitatory inputs, confined to the same olivary dendritic spine, can efficiently cancel each other if they arrive within a certain time window. About half of the inhibitory inputs to olivary glomeruli originate in the deep cerebellar nuclei and are regarded as an inhibitory feedback. The second property is subthreshold membrane potential oscillations, a property of the electrotonically coupled olivary network. Extrinsic synaptic inputs to the nucleus modulate the subthreshold oscillations, and consequently, the response properties of olivary neurons. A considerable amount of indirect evidence indicates that the occurrence of oscillations corresponds to states of increased responsiveness of the neurons to peripheral stimulation. The sensory filtering role of the inferior olivary nucleus invites comparison between the cerebellum and cerebellar-like structures. This comparison sheds important light on the function of the cerebellum.     

The great deceiver: the role of convulsive syncope in the history of epilepsy

Because of its high medical and social profile, epilepsy has a voluminous documented history. For centuries it has been the subject of much speculation and attempted explanation. Even from antiquity examples taken from every day life have been used to explore, by analogy, the mechanism of epileptic seizures; and the convulsive phenomena of acute exsanguination have attracted much attention for this reason. A survey of the aspects and the consequences of this exercise in the study of seizure mechanisms shows that, until Jackson and Gowers emphasised the central role of the cortex in human epilepsy, a very complex schema had been constructed to explain epilepsy. This had been based upon erroneous information obtained by analogy from the convulsive phenomena of syncope and exsanguination. Over the millennia this mistaken concept served to divert scientific endeavour in attempts to explain and unravel the bases of epilepsy. It was only little more than a century ago that this concept was finally abandoned.     

Failure to replicate the dorsal bundle extinction effect: Telencephalic norepinephrine depletion does not reliably increase resistance to extinction but does augment gustatory neophobia

Depletion of telencephalic noradrenaline (Ne), caused by lesion of the dorsal tegmental bundle, has been reported to increase persistance of non-reinforced responding in various operant tasks. This has been referred to as the dorsal bundle extinction effect (DBEE). In an effort to reproduce this effect, rats receiving 6-hydroxydopamine lesions of the dorsal Ne bundle (DB-OHDA) were compared to controls during extinction of a continous food rewarded (CRF) lever-response. While the lesion group showed an increase in responding during initial extinction, no significant difference in resistance to extinction using a 2-min non-response criterion was obtained. Moreover, no differences in reinforced response rates were observed with CRF, fixed ratio (FR-15, FR-30, FR-60) or variable interval (VI-30, VI-60, VI-20 s) schedules of reinforcement. In order to test the hypothesis that the DBEE is dependent on time of behavioral testing after surgery, subsequent experiments were performed where rats began CRF operant training 5, 17, 31 or 110 days post-lesion. No differences in resistance to extinction were observed between lesion and control rats at any post-lesion interval. Neonatal treatment with 6-OHDA which permanently lesions forebrain Ne terminals also failed to prolong extinction. Finally, when both DB-OHDA and neonatal rats were given a choice between water and saccharine the lesioned animals exhibited a neophobic reaction whereby they drank significantly less saccharine. We conclude that while the DBEE is not a reliably reproducible phenomenon other effects of forebrain Ne lesions, such as neophobia, appear to be robust.