Brisk reflexes

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Brisk reflexes

What does a brisk reflex mean? Deep Tendon Reflexes. When reflexes are very briskclonus is sometimes seen. This is a repetitive vibratory contraction of the muscle that occurs in response to muscle and tendon stretch.

See Full Answer. What is the reflex test for? Reflex tests are performed as part of a neurological exam, either a mini-exam done to quickly confirm integrity of the spinal cord or a more complete exam performed to diagnose the presence and location of spinal cord injury or neuromuscular disease. Deep tendon reflexes are responses to muscle stretch. Hyperreflexia refers to hyperactive or repeating clonic reflexes.

These usually indicate an interruption of corticospinal and other descending pathways that influence the reflex arc due to a suprasegmental lesion, that is, a lesion above the level of the spinal reflex pathways. How are reflexes graded? Clonus is a repetitive, usually rhythmic, and variably sustained reflex response elicited by manually stretching the tendon. Reflex testing is an important tool in providing timely, cost-effective and quality care to patients.

A reflex test is a laboratory test performed and charged for subsequent to an initially ordered and resulted test. Shaded blocks indicate those tests that are performed by a referral laboratory.

What is the muscle that responds in the triceps reflex? The triceps reflex, a deep tendon reflex, is a reflex as it elicits involuntary contraction of the triceps brachii muscle. It is initiated by the Cervical of the neck region spinal nerve 7 nerve root the small segment of the nerve that emerges from the spinal cord.

Reflexes are set motor responses to specific sensory stimuli.

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All reflexes share three classical characteristics : they have a sensory inflow pathway, a central relay site, and a motor outflow pathway. Together, these three elements make up the reflex arc. A monosynaptic reflex extension of the leg resulting from a sharp tap on the patellar tendon. It helps maintain and upright position. It's effector muscles are located in the quadriceps femoris. It's connected to the withdrawal reflex. The quadriceps femoris is the effector muscle of the patellar reflex.

The dorsal roots of spinal nerves contain the axons of the motor neurons. The normal patellar reflex response involves extension of the leg at the knee joint.Search for: home. MSWorld social media. MSWorld centers. MSWorld brochure. MSWorld guidelines. If this is your first visit, be sure to check out the FAQ by clicking the link above.

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Page 1 of 2 1 2 Jump to page:. Hello Donna. Thanks koko, But isnt that bad? Why didnt neuro do an mri? That means i have a spinal lesion? Hi donnainct, I think the best person to ask why a MRI wasn't done would be your neuro! As far as all with MS having hyperactive reflexes, this too is hard to tell as we are all so different with placements of lesions.

We were just talking about this a few days ago Thanks seasha, I just was wondering,maybe neuro didnt feel i needed an mri. ILL just keep on truckin lol. Originally Posted by donnainct. Lord, keep your arm around my shoulder and your hand over my mouth. I have brisk reflexes too. I always thought that was a good sign. My doctor said it is a bad sign. She didn't explain to me what that meant.

Plantar reflex

I had brisk knee reflexes for a year or so and about kicked my neurologist off her stool! I also never have any ankle reflexes. And I have at times had brisk arm reflexes too. Is it normal for them to come and go like that? Joy is not the absence of suffering. It is the presence of God. Cut aspartame from my diet in and my symptoms have slowly disappeared.

Join Date Oct Location california Posts I just read that thread on brisk reflexes and I have the opposite problem. I'll be doing a repeat emg this Weds. So I'm dx.This is known as the Jendrassik maneuver. It is key to compare the strength of reflexes elicited with each other. Have the patient sit up on the edge of the examination bench with one hand on top of the other, arms and legs relaxed.

Instruct the patient to remain relaxed. The biceps reflex is elicited by placing your thumb on the biceps tendon and striking your thumb with the reflex hammer and observing the arm movement. Repeat and compare with the other arm. The brachioradialis reflex is observed by striking the brachioradialis tendon directly with the hammer when the patient's arm is resting. Strike the tendon roughly 3 inches above the wrist.

Note the reflex supination. Repeat and compare to the other arm. The biceps and brachioradialis reflexes are mediated by the C5 and C6 nerve roots. The triceps reflex is measured by striking the triceps tendon directly with the hammer while holding the patient's arm with your other hand. The triceps reflex is mediated by the C6 and C7 nerve roots, predominantly by C7.

With the lower leg hanging freely off the edge of the bench, the knee jerk is tested by striking the quadriceps tendon directly with the reflex hammer. Repeat and compare to the other leg. The knee jerk reflex is mediated by the L3 and L4 nerve roots, mainly L4.

Benign Fasciculation Syndrome (BFS) Constant Muscle Twitching

Insult to the cerebellum may lead to pendular reflexes. Pendular reflexes are not brisk but involve less damping of the limb movement than is usually observed when a deep tendon reflex is elicited. Patients with cerebellar injury may have a knee jerk that swings forwards and backwards several times. A normal or brisk knee jerk would have little more than one swing forward and one back.

Pendular reflexes are best observed when the patient's lower legs are allowed to hang and swing freelly off the end of an examining table. The ankle reflex is elicited by holding the relaxed foot with one hand and striking the Achilles tendon with the hammer and noting plantar flexion.

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Compare to the other foot. The ankle jerk reflex is mediated by the S1 nerve root. The plantar reflex Babinski is tested by coarsely running a key or the end of the reflex hammer up the lateral aspect of the foot from heel to big toe.

The normal reflex is toe flexion. If the toes extend and separate, this is an abnormal finding called a positive Babinski's sign. A positive Babinski's sign is indicative of an upper motor neuron lesion affecting the lower extremity in question.

The Hoffman response is elicited by holding the patient's middle finger between the examiner''s thumb and index finger. Ask the patient to relax their fingers completely. Once the patient is relaxed, using your thumbnail press down on the patient's fingernail and move downward until your nail "clicks" over the end of the patient's nail.

Normally, nothing occurs.

brisk reflexes

A positive Hoffman's response is when the other fingers flex transiently after the "click". Repeat this manuever multiple times on both hands. A positive Hoffman response is indicative of an upper motor neuron lesion affecting the upper extremity in question.

Finally, test clonus if any of the reflexes appeared hyperactive. Hold the relaxed lower leg in your hand, and sharply dorsiflex the foot and hold it dorsiflexed. Feel for oscillations between flexion and extension of the foot indicating clonus.

Normally nothing is felt.The plantar reflex is a reflex elicited when the sole of the foot is stimulated with a blunt instrument. The reflex can take one of two forms. In healthy adults, the plantar reflex causes a downward response of the hallux flexion.

brisk reflexes

An upward response extension of the hallux is known as the Babinski response or Babinski signnamed after the neurologist Joseph Babinski. The presence of the Babinski sign can identify disease of the spinal cord and brain in adults, and also exists as a primitive reflex in infants. While first described in the medical literature by Babinski in[2] the reflex has been identified in art at least as early as Botticelli 's Madonna and Child With an Angelpainted in the mid- 15th century.

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The lateral side of the sole of the foot is rubbed with a blunt instrument or device so as not to cause pain, discomfort, or injury to the skin; the instrument is run from the heel along a curve to the toes [4] metatarsal pads.

Many reflex hammers taper at the end of the handle to a point which was used for testing the plantar response in the past, however, due to the tightening of infection control regulation this is no longer recommended. Either a single use device or the thumb nail should be used. As the lesion responsible for the sign expands, so does the area from which the afferent Babinski response may be elicited.

The Babinski response is also normal while asleep and after a long period of walking. The Babinski sign can indicate upper motor neuron lesion constituting damage to the corticospinal tract.

Occasionally, a pathological plantar reflex is the first and only indication of a serious disease process and a clearly abnormal plantar reflex often prompts detailed neurological investigations, including CT scanning of the brain or MRI of the spine, as well as lumbar puncture for the study of cerebrospinal fluid.

The phrase "negative Babinski sign" is sometimes used for the normal flexor plantar response. Infants will usually show an extensor response. In one study of healthy infants, the response to testing was extensor in The extensor response usually disappears — giving way to the flexor response — by 12 months of age.

The Hoffmann's reflex is sometimes described as the upper limb equivalent of the Babinski sign [11] because both indicate upper motor neuron dysfunction. Mechanistically, they differ significantly; the finger flexor reflex is a simple monosynaptic spinal reflex involving the flexor digitorum profundus that is normally fully inhibited by upper motor neurons. The pathway producing the plantar response is more complicated, and is not monosynaptic.

The plantar reflex can be elicited in a number of ways, which were described in the late 19th and early 20th century. These have their own eponyms. From Wikipedia, the free encyclopedia.


If the reflex occurs in adults as illustrated at bottom it may be due to nerve damage or disease. Main article: Primitive reflexes. Main article: Hoffmann's reflex. Archives of Neurology. A Dictionary of Neurological Signs.

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Journal of Paediatrics and Child Health. Retrieved 24 May N Engl J Med. Pediatric Neurology.

Deep Tendon Reflexes

Neurology India. Kenneth; Hall, W. Dallas; Schlossberg, J. In Walker, H. Kenneth ed.Increased brisk Reflexes: Tendon reflexes that are abnormally quick or exaggerated in range of movement. See detailed information below for a list of 10 causes of Increased brisk Reflexesincluding diseases and drug side effect causes. The following medical conditions are some of the possible causes of Increased brisk Reflexes.

There are likely to be other possible causes, so ask your doctor about your symptoms. Upper motor neuron lesion Stroke Blood clot in brain Ischaemic stroke see Stroke symptoms Haemorrhage into brain tissue Haemorrhagic stroke Brain tumour Trauma causing brain damage Multiple sclerosis Infections HIV Patient anticipating reflex test and "helping" examiner more causes Review causes of types of Increased brisk Reflexes in more specific categories: Increased brisk Reflexes in pregnancy 6 causes more types Causes of General Symptom Types Research the causes of these more general types of symptom: Reflex Abnormality 3 causes Reflex symptoms causes Nerve symptoms causes Autonomic nerve symptoms causes Muscle symptoms causes Movement symptoms causes Musculoskeletal symptoms causes Neurological symptoms causes Tendon symptoms causes Brain symptoms causes Head symptoms causes more symptoms Misdiagnosis and Increased brisk Reflexes Vitamin B12 deficiency under-diagnosed : The condition of Vitamin B12 deficiency is a possible misdiagnosis of various conditions, such as multiple sclerosis see symptoms of multiple sclerosis.

See symptoms of Vitamin B12 deficiency or misdiagnosis Increased brisk Reflexes: Undiagnosed Conditions Conditions that are commonly undiagnosed in related areas may include: Nerve Disorders: serious diseases commonly undiagnosed: Diabetic Neuropathy -- Undiagnosed Peripheral Neuropathy -- Undiagnosed Multiple Sclerosis -- Undiagnosed more This information refers to the general prevalence and incidence of these diseases, not to how likely they are to be the actual cause of Increased brisk Reflexes.

See the analysis of the prevalence of 10 causes of Increased brisk Reflexes. The following list of conditions have ' Increased brisk Reflexes ' or similar listed as a symptom in our database.

This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom. Select from the following alphabetical view of conditions which include a symptom of Increased brisk Reflexes or choose View All. I cannot get a diagnosis. Please help.

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What is the best treatment for this? Medical story forums: If you have a medical story then we want to hear it. Tell us your medical story. Share your misdiagnosis story.Hi I have varying information on what brisk refelxes mean. This in me has never been picked up before, although having said that a 10 months after a car accident I had drop foot and clonus on my left side.

I believe from what I have read clonus is related to brisk reflexes. Anyway, as a result of my last exam I am being sent for an MRI but only of the brain. I read this morning in the forum that brisk reflexes are indication of a spinal cord problem not brain. I hope I am not going to have a wasted journey, if they are not looking beyond the brain Some people naturally have brisk reflexes and they're probably looking at your brain first as a precautionary measure before looking elsewhere.

Introduction to how reflexes work - reflex arc, monosynaptic and polysynaptic reflexes

My neuro is a lovely man but I had to ask him to scan my spine Turns out I have a lesion on my spine. Don't worry, its not a waste of time having the brain MRI See what the results are, you may want to discuss at your next neuro appointment about wanting a scan on your spine. Neurologist are not really keen on scanning the spine. I suppose if you think about the anatomy of the body, the spine is obviously not flat is it?

I have a lot of neck pain and it wouldn't surprise me if I had a lesion there, buy hey ho I'll never know. All the best to you, keep us up to date with how you get on. I thought brisk reflexes were spine neuro problem but heard it can be someone's normal or caused by stress isn't everything lol Axx. I was informed by my GP that some people have brisk reflexes naturally. She does and was the scape goat for testing reflexes whilst studying medicine lol. So doesn't always have to be caused by a spine neuro problem.

Hi Lou Lou x if your reflexes were brisk enough to be noted as abnormal and you had myoclonus then this indicates an upper motor neuron issue x. Neurologists are trained to distinguish between stress induced reflex responses and those that indicate abnormalities - I would query this with your specialist not your GP xxxjenxxx.

Generally - and I mean generally as MS doesn't always follow the rules - symptoms and clinical signs tend to be on one side with MSers. I don't know why. Neuros see it in people who have had a stroke, or have a brain or spinal cord tumour — it can also be present when someone has metabolic abnormalities like hypoglycaemia.

Thyroiod problems and hypoxia.I've also been a long term migraine sufferer and have had quite a few headaches recently. I don't think I had any vision problems so don't think it was optic neuritis but could have been????

My doc did a blood test for temporal or giant cell arteritis which was negative. She is going to write a letter to my GP asking for me to be referred to a neuro. So, I don't know if all this is MS or not - I realise it could be other things but a possible MS diagnosis been in my mind for nearly a year now and I've wanted a referral to neuro for ages, even if just to rule neuro stuff out.

I just never seem to be able to ask when I go to the GP because there is always a new theory and something different she wants to test. Am I right, though, that brisk reflexes are a definite sign of neuro problems? Is this just one symptom too many to ignore that possibility? I would SO like some answers as I've been thinking I've been going mad for ages now. I know I come across to docs as a hypochondriac but I really am experiencing all these symptoms and I just want to know what's wrong, even if that means an MS diagnosis.

Having said that, I've started worrying myself today that I could also potentially have a brain tumour - if you Google brisk reflexes the options that come up are MND don't think I have thatAIDS definitely don't have thatMS and brain tumour. Here I go again - no wonder the doc thinks I'm a hypochondriac.

brisk reflexes

Anyway, I guess this long post is just to say does this sound like it could be MS? OR anything else? I've made an appointment with the doc but its not for another week and a half. I could ask for an emergency appointment but I guess I don't need that and anyway, it would probably be with a different doc. Despite putting everything down to depression, my own doc has been quite supportive.

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She's organised x-rays and loads of blood tests so it hasn't just been the 'your depressed' route. By the way, I am on calcium and vit D because of a premature menopause. When I had the eye pain, she tested for vit D levels and they are very slightly low, despite the supplements but it's nothing significant and not likely to be the cause of any symptoms. Sorry, this has been such a ramble but I've been in pieces today and just need to share it all with someone.

If you've kept reading this far, thank you very much. Hi lilacgirl, if not already done,may I suggest you tell the Dr you think there is more going on and you would appreciate a refferal to a neurologist. Maybe take the written list of all your symptoms to your g. The only way I found out is with an MRI I had several CT scans on my neck back knees referral to orthapedics etc etc to no avail over a 3 year period.

Thank you for your message - it really helps just to know there are people out there who are on my side. I think there won't be a problem with the neuro referral at my next GP appointment as I will have the letter from the osteopath saying I need one.


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