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Related Experiment Videos

The crossed upgoing toe sign: a clinical study.

E W Willoughby, R Eason

    Annals of Neurology
    |October 1, 1983
    PubMed
    Summary

    The crossed upgoing toe sign is not a reliable indicator of pyramidal tract dysfunction. This neurological sign is often absent in severe cases and frequently appears falsely positive in healthy individuals.

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    Area of Science:

    • Neurology
    • Neuroscience
    • Clinical Assessment

    Background:

    • Pyramidal tract dysfunction is a key indicator of neurological disorders.
    • The Babinski sign is a well-established reflex for assessing pyramidal tract integrity.
    • Novel reflex signs are continuously evaluated for diagnostic utility.

    Purpose of the Study:

    • To compare the diagnostic value of the crossed upgoing toe sign against the plantar response (Babinski sign).
    • To determine the sensitivity and specificity of the crossed upgoing toe sign in identifying pyramidal tract lesions.
    • To assess the utility of the crossed upgoing toe sign in localizing pyramidal tract lesions.

    Main Methods:

    • A comparative study involving 125 healthy subjects and 192 patients with neurological disorders.
    • Systematic assessment of the crossed upgoing toe sign and plantar response in all participants.
    • Correlation of reflex findings with the presence and location of pyramidal tract lesions.

    Main Results:

    • A positive crossed upgoing toe sign showed a significant association with partial pyramidal tract lesions in the cerebral hemisphere, similar to Babinski's sign.
    • The crossed upgoing toe sign was absent in cases of severe pyramidal weakness leading to paralysis of great toe dorsiflexion.
    • This sign was rarely observed in spinal cord pyramidal tract lesions and frequently yielded false positive results in normal subjects.

    Conclusions:

    • The crossed upgoing toe sign has limited value as a sensitive indicator of pyramidal tract lesions.
    • Its utility in differentiating cerebral hemisphere from spinal cord lesions is minimal due to frequent false positives and absence in severe weakness.

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