Translate this page into:
The ‘other Babinski sign’ in child neurology
*For correspondence: drlokeshsaini@gmail.com
-
Received: ,
This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
This article was originally published by Wolters Kluwer - Medknow and was migrated to Scientific Scholar after the change of Publisher.
A 24 month old female child†, developmentally normal girl, presented to the Pediatric Neurology Unit, Postgraduate Institute of Medical Education & Research, Chandigarh, India, in July 2019, with near-continuous twitching of the left eyelid, forehead and cheek noted since two months of age. Twitching persisted even in sleep and worsened during crying and eating. She was put on three antiepileptic drugs with no response. Examination revealed left hemifacial spasm (HFS) with 'the other Babinski sign or browlift sign' (Video). This sign occurs as a result of different suprasegmental innervation of these muscles; signifying peripheral co-activation at the level of the seventh nerve. This occurs as a result of different suprasegmental innervation of these muscles; signifying peripheral co-activation at the level of the seventh nerve. Rest of the examination was unremarkable. Electroencephalography (Figure) was normal. Neuroimaging revealed fourth ventricular hamartoma. Hence, the final diagnosis of left HFS with fourth ventricular hamartoma was made. She partly responded to carbamazepine and was planned for gamma-knife ablation of the hamartoma.
- Sleep electroencephalography epoch of the index child. 10 sec electroencephalography epoch (bipolar montage; sensitivity: 70 uV; sweep speed: 30 mm/s) showing repetitive, abrupt-onset, bursts of fast activity (arrows) over the left frontotemporal electrodes time locked with the event, simulating myogenic artefact.
The 'other Babinski sign' (co-contraction of ipsilateral orbicularis oculi and frontalis resulting in simultaneous eye closure and browlift) is an under-recognized but useful sign in HFS. It helps in distinguishing HFS from epileptic events and blepharospasm.
Video available at ijmr.org.in.
Conflicts of Interest: None.
