Babinski Sign (Plantar Reflex)

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To check the plantar reflex use your fingernail or a similarly sharp object and stroke the lateral foot, sliding medially across the MTPs. This patient’s big toe goes upward, specifically at the extensor hallucis longus, which is a positive Babinski sign suggesting an upper motor neuron lesion, in this case due to an epidural abscess. It may also be positive in postictal or intoxicated patients. If the toes don’t move this is called “silent” or “mute” and that can be normal as long as it’s symmetric.

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