Resumos
Foram estudadas comparativamente as respostas motoras reflexas desencadeadas por estímulo sensitivo táctil e por estímulo frio, aplicados à face plantar dos pés, de 31 pessoas sadias e de 49 pacientes com afecções do sistema nervoso. Êstes foram grupados segundo apresentassem quadros clínicos sugestivos de comprometimento do sistema nervoso periférico (7 pacientes) ou do SNC. Dêstes últimos, um grupo de pacientes não apresentava sintomas próprios à lesão do neurônio motor central (12 pacientes). Nos demais havia sintomas sugestivos de lesão do neurônio motor central e foram considerados segundo apresentassem, ou não, sinal de Babinski à pesquisa mediante o estímulo táctil: em 9 o sinal de Babinski não era evidenciado e nos restantes estava presente. Êste último grupo de pacientes compreende 13 casos nos quais o sinal de Babinski ocorria unilateralmente e 8, nos quais ocorria bilateralmente. Os resultados permitiram verificar que o estímulo frio apenas ocasionalmente desencadeia a resposta que caracteriza o reflexo cutâneo plantar normal. Por outro lado, o estímulo frio possibilita com freqüência aproximadamente semelhante àquela observada para o estímulo táctil, a verificação do sinal de Babinski. Com freqüência a resposta que caracteriza o sinal de Babinski é mais nítida e duradoura quando se emprega o estímulo frio. Êsses dados mostram que o emprêgo do estímulo frio representa modalidade de semiotécnica útil para a elucidação de casos nos quais haja dúvidas quanto à presença de sinal de Babinski quando a pesquisa é feita segundo a técnica clássica. De fato, com o estímulo frio, observa-se tendência a refôrço do sinal de Babinski quando êle está presente; na sua ausência o mesmo tipo de estímulo não costuma determinar qualquer tipo de resposta.
Thirty one healthy people and 49 patients suffering from diseases of the nervous system were studied in order to evaluate the technique of eliciting Babinski's signal by means of cold stimulation as it was proposed by Dalsgaard-Nielsen. The patients were distributed in 4 groups. Patients of group 1 (7 cases) had clinical signs of peripheric nervous system impairment. Patients of groups 2, 3 and 4 had clinical signs of CNS impairment. In those of group 2 (12 cases) there were no evidences of central motor lesions. In the remaining patients these evidences were found and they were grouped considering the absence (group 3: 9 cases) or the presence (group 4: 21 cases) of Babinski's sign, when tactile stimulation was used. The results obtained were compared to those found in the same people by means of tactile plantar stimulation. For both methods, results were considered to be: absent, when any motor reflex activity was elicited; in-characteristic, when it was observed a rapid dorsiflexion of toes; normal, when the ventral flexion of toes proper to cutaneo-plantar reflex occurred and Babinski's sign, when it occurred the hallux dorsiflexion proper to this signal. The results obtained show that the plantar cold stimulation is not useful for eliciting the normal cutaneo-plantar reflex. It was elicited by this method only in 2 healthy people and in 3 patients of groups 1 and 2. Babinski's toe phenomenon was elicited by cold stimulation in 18 patients of group 4. It was observed that the response was more characteristic and remained by a longer period when cold stimulation was used. These aspects were observed specially in those patients that had bilateral Babinski's sign. The results show that cold stimulation of the plantar region is an useful method of eliciting Babinski's toe phenomenon. The qualitative aspects of the motor response which were refered show that cold stimulation is an useful method of investigation to be employed specially when doubtful responses are obtained by tactile stimulation techniques.
Sinal de Babinski: emprêgo do frio como estímulo sensitivo
Evaluation of cold stimulation tecnique for eliciting Babinski's toe Phenomenon
J. A. Gonçalves da SilvaI; A. Spina-FrançaII
IMédico estagiário; Clínica Neurológica da Fac. Med. da Univ. de São Paulo (Prof. A. Tolosa)
IIProfessor assistente; Clínica Neurológica da Fac. Med. da Univ. de São Paulo (Prof. A. Tolosa)
RESUMO
Foram estudadas comparativamente as respostas motoras reflexas desencadeadas por estímulo sensitivo táctil e por estímulo frio, aplicados à face plantar dos pés, de 31 pessoas sadias e de 49 pacientes com afecções do sistema nervoso. Êstes foram grupados segundo apresentassem quadros clínicos sugestivos de comprometimento do sistema nervoso periférico (7 pacientes) ou do SNC. Dêstes últimos, um grupo de pacientes não apresentava sintomas próprios à lesão do neurônio motor central (12 pacientes). Nos demais havia sintomas sugestivos de lesão do neurônio motor central e foram considerados segundo apresentassem, ou não, sinal de Babinski à pesquisa mediante o estímulo táctil: em 9 o sinal de Babinski não era evidenciado e nos restantes estava presente. Êste último grupo de pacientes compreende 13 casos nos quais o sinal de Babinski ocorria unilateralmente e 8, nos quais ocorria bilateralmente.
Os resultados permitiram verificar que o estímulo frio apenas ocasionalmente desencadeia a resposta que caracteriza o reflexo cutâneo plantar normal. Por outro lado, o estímulo frio possibilita com freqüência aproximadamente semelhante àquela observada para o estímulo táctil, a verificação do sinal de Babinski. Com freqüência a resposta que caracteriza o sinal de Babinski é mais nítida e duradoura quando se emprega o estímulo frio. Êsses dados mostram que o emprêgo do estímulo frio representa modalidade de semiotécnica útil para a elucidação de casos nos quais haja dúvidas quanto à presença de sinal de Babinski quando a pesquisa é feita segundo a técnica clássica. De fato, com o estímulo frio, observa-se tendência a refôrço do sinal de Babinski quando êle está presente; na sua ausência o mesmo tipo de estímulo não costuma determinar qualquer tipo de resposta.
ABSTRACT
Thirty one healthy people and 49 patients suffering from diseases of the nervous system were studied in order to evaluate the technique of eliciting Babinski's signal by means of cold stimulation as it was proposed by Dalsgaard-Nielsen.
The patients were distributed in 4 groups. Patients of group 1 (7 cases) had clinical signs of peripheric nervous system impairment. Patients of groups 2, 3 and 4 had clinical signs of CNS impairment. In those of group 2 (12 cases) there were no evidences of central motor lesions. In the remaining patients these evidences were found and they were grouped considering the absence (group 3: 9 cases) or the presence (group 4: 21 cases) of Babinski's sign, when tactile stimulation was used.
The results obtained were compared to those found in the same people by means of tactile plantar stimulation. For both methods, results were considered to be: absent, when any motor reflex activity was elicited; in-characteristic, when it was observed a rapid dorsiflexion of toes; normal, when the ventral flexion of toes proper to cutaneo-plantar reflex occurred and Babinski's sign, when it occurred the hallux dorsiflexion proper to this signal.
The results obtained show that the plantar cold stimulation is not useful for eliciting the normal cutaneo-plantar reflex. It was elicited by this method only in 2 healthy people and in 3 patients of groups 1 and 2.
Babinski's toe phenomenon was elicited by cold stimulation in 18 patients of group 4. It was observed that the response was more characteristic and remained by a longer period when cold stimulation was used. These aspects were observed specially in those patients that had bilateral Babinski's sign. The results show that cold stimulation of the plantar region is an useful method of eliciting Babinski's toe phenomenon. The qualitative aspects of the motor response which were refered show that cold stimulation is an useful method of investigation to be employed specially when doubtful responses are obtained by tactile stimulation techniques.
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Clínica Neurológica - Faculdade de Medicina da Universidade de São Paulo - Caixa Postal 3461 - São Paulo, SP - Brasil
- DALSGAARD-NIELSEN, T. - A method of eliciting Babinski's toe phenomenon by means of cold stimulation. Acta neurol. scandinav. 42:90-96, 1966.
Datas de Publicação
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Publicação nesta coleção
14 Ago 2013 -
Data do Fascículo
Set 1966
