BABINSKI'S SIGN

Joseph Babinski (1857-1932), a French neurologist of Polish descent, was the first person to describe extension of the big toe following stimulation of the sole of the foot on 22 February 1896 (Babinski, 1896). He referred to the sign as 'phénomène des orteils' (toes phenomenon) but it is now usually referred to eponymously as the 'Babinski sign' or descriptively as the extensor plantar response.

Reduced MTR in the corticospinal tract and normal T 2 in amyotrophic lateral sclerosis

The presence or absence of a Babinski sign can be puzzling, but in the light of existing pathological studies it is more fruitful to consider which pyramidal tract fibres release it than whether they release it. This was investigated clinically, by looking for correlations with other reflex changes and with motor deficits in the leg. A survey of 50 patients with a unilateral Babinski sign and six patients who lacked it in spite of other pyramidal tract signs was supplemented with follow-up of the patients who had acute lesions. Appearance of the Bibinski sign proved to depend on the interaction of two factors: (1) activity (not necessarily hyperactivity) in the segmental pathways of the flexion synergy; (2) a motor deficit of the foot, in some cases consisting only in an impairment of rapid foot movements, and probably representing a disturbance of direct pyramidal tract projections to distal motoneurones.

Motor deficit is the most common disability after stroke, and early prediction of motor outcome is critical for early interventions. Here, we constructed a fine map of the corticospinal tract (CST) for early prediction of motor outcome and for understanding the secondary brain changes after subcortical stroke. Diffusion spectrum imaging data from 50 healthy adults were used to reconstruct fine maps of CST with different origins, including primary motor area (M1), primary sensory area (S1), premotor cortex, and supplementary motor area (SMA). Their diffusion properties correlated with motor functions in healthy adults. The impacts of the impairments of different CST on motor outcomes and on structural and functional changes of brain were investigated in 136 patients with subcortical stroke by combining CST damage-symptom association study and voxel-based lesion-symptom mapping. In healthy adults, the isotropy of M1 fiber correlated with walking endurance and that of SMA fiber with motor dexterity. In chronic stroke patients, the integrity of M1 and SMA fibers showed the most significant correlation with motor deficits. The percentage of early damage of M1 and SMA fibers correlated with that of chronic motor deficits. Voxel-based lesion-symptom mapping revealed that acute stroke lesions in the bilateral M1 and right SMA fibers were associated with chronic motor deficits. The early damage of M1 fiber negatively correlated with the integrity of M1-M1 fiber, and the early damage of SMA fiber negatively correlated with gray matter volume of the contralateral cerebellum in the chronic stage. The CST that originated from the M1 and SMA are closely associated with motor outcomes and brain structural changes, and the fine maps of CST from these 2 cortical areas are useful in assessing and predicting long-term motor outcome in patients with subcortical stroke.

296 -The effects of early intervention on autism spectrum disorder prognosis: a narrative review

The corticospinal system—with its direct spinal pathway, the corticospinal tract (CST) – is the primary system for controlling voluntary movement. Our approach to CST repair after injury in mature animals was informed by our finding that activity drives establishment of connections with spinal cord circuits during postnatal development. After incomplete injury in maturity, spared CST circuits sprout, and partially restore lost function. Our approach harnesses activity to augment this injury-dependent CST sprouting and to promote function. Lesion of the medullary pyramid unilaterally eliminates all CST axons from one hemisphere and allows examination of CST sprouting from the unaffected hemisphere. We discovered that 10 days of electrical stimulation of either the spared CST or motor cortex induces CST axon sprouting that partially reconstructs the lost CST. Stimulation also leads to sprouting of the cortical projection to the magnocellular red nucleus, where the rubrospinal tract originates. Coordinated outgrowth of the CST and cortical projections to the red nucleus could support partial re-establishment of motor systems connections to the denervated spinal motor circuits. Stimulation restores skilled motor function in our animal model. Lesioned animals have a persistent forelimb deficit contralateral to pyramidotomy in the horizontal ladder task. Rats that received motor cortex stimulation either after acute or chronic injury showed a significant functional improvement that brought error rate to pre-lesion control levels. Reversible inactivation of the stimulated motor cortex reinstated the impairment demonstrating the importance of the stimulated system to recovery. Motor cortex electrical stimulation is an effective approach to promote spouting of spared CST axons. By optimizing activity-dependent sprouting in animals, we could have an approach that can be translated to the human for evaluation with minimal delay.

Proximal and distal impairments in rat forelimb use in reaching follow unilateral pyramidal tract lesions

Studies on the mechanism of the action of visual afferents on motor cortex excitability

1. Experiments were performed to investigate whether the sensitivity of the cerebral cortex to produce convulsive activity was modified by a transient epileptic focus. For this reason, 30 awake rats received two intracerebral penicillin (PCN) injections (125 IU/0.5 microliter solvent), the first one into the motor or visual cortex, the second one two weeks later into the motor cortex. Convulsive activity was recorded by means of EEG. 2. After the first PCN injection, interictal activity lasted 143.4 +/- 19.3, S.E. min (n = 17) in the motor cortex group, but 426 min (n = 13) in the visual group (p < 0.05). The median frequency of interictal potentials (np/min) was significantly lower in the motor cortex group than in the visual cortex group (18.4 and 25.5 np/min, respectively, p < 0.05). The period between the onset of the first and last seizure was 110.6 +/- 10.2 min for the motor cortex group, and 119.8 +/- 31.2 min for the visual cortex group. The seizures lasted longer and were less frequent in the motor than in the visual group (length: 12.5 +/- 1.1 vs 7.5 +/- 2.8 s; number: 43 +/- 11 vs 131 +/- 40, respectively, 0.05 < p < 0.1). 3. After the second PCN injection which was performed in all rats into the motor cortex, the duration but not the frequency of the interictal activity depended on the site of the first injection. The duration after this treatment was 96.8 +/- 43.3, S.E. min in the visual and 173.2 +/- 30.5 min in the motor cortex group (p < 0.05), while the frequency values of both groups were at a similar level (20.5 +/- 2.1 vs 18.9 +/- 1.7 np/min, respectively). Also the period with generalized activity after the second PCN injection was shorter in the visual than in the motor cortex group (43.9 +/- 32.3 vs 114.3 +/- 31.8 min, respectively, p < 0.05), and the number of seizures slightly lower (8 +/- 210 vs 54 +/- 30, respectively, p < 0.1). The length of the seizures was rather equal 11.6 +/- 2.5 vs 12.0 +/- 3.5 s, respectively, p > 0.1). 4. It is postulated that a transient epileptiform focus can induce, in a site-specific manner, long-lasting anticonvulsant effects. Therefore, epileptogenic experience may not only sensitize the brain, but also desensitize it with respect to the induction and duration of epileptiform activity.

Specogna, AV; Patten, SB; Hill, MD; University of Calgary, Calgary, AB Background: Previous studies have examined predictors of treatment costs after Spontaneous Intracerebral Hemorrhage (ICH) in various countries and healthcare systems. Currently however, there is no clear understanding of which factors are associated with cost in any Canadian setting and thus no way of understanding how to plan ICH healthcare spending. Methods: We used a retrospective case series study design and adjusted linear regression to investigate if an association existed between the total cost of ICH hospital care in a Canadian health centre and age (years), gender (female vs. male), Charlson Comorbidity Index (0 vs. ≥1), in-hospital mortality (alive vs. dead), and having surgery (no vs. yes). Economic, treatment, and patient data were obtained from administrative sources. Total inflation-adjusted hospital cost per discharge was estimated in Canadian Dollars and log transformed for all analyses. Results: Analyses were performed using 987 consecutive ICH discharges from 1999 to 2008. The total cost of ICH hospital care was highly variable (mean cost per discharge=$25,613.96±$36,116.33; min $446.81 to max $326,275.10). Older age (β=–0.0057; 95% CI: –0.0103 to –0.0011) and death in hospital (β=–0.4859; 95% CI: –0.6357 to –0.3342) were significantly associated with lower total hospital cost per discharge. Whereas Charlson Comorbidity Index of ≥1 (β=0.6489; 95% CI: 0.5063 to 0.7916) and having surgery (β=1.3552; 95% CI: 1.1893 to 1.5210) were significantly associated with higher total hospital cost per discharge. Gender was not significantly associated with cost (β=0.0727; 95% CI: –0.0679 to 0.2134). Conclusions: To our knowledge this is the first study to examine predictors of ICH treatment costs in Canada. In a Canadian health centre, ICH treatment costs were significantly associated with patient age, level of comorbidity, in-hospital mortality, and surgical treatment. This study provides evidence that it may be reasonable to consider …

We present the cases of two otherwise healthy adults, one with meningitis and another with a subdural abscess, with both conditions attributable to Streptococcus pneumoniae. A 31-year-old man was admitted with a 3-day history of fever, headache, and vomiting. Physical examination revealed intermittent confusion, irritability, and neck stiffness. Cerebrospinal fluid (CSF) culture was positive for S. pneumoniae. Contrast-enhanced magnetic resonance imaging (C-MRI) revealed multiple small lesions on the bilateral frontal lobes. Intravenous ceftriaxone and vancomycin were administered, followed by intravenous moxifloxacin. His symptoms resolved within 3 months. Additionally, a 66-year-old man was admitted for acute fever with confusion, abnormal behavior, and a recent history of acute respiratory infection. Physical examination revealed confusion, neck stiffness, and a positive right Babinski sign. CSF metagenomic analysis detected S. pneumoniae. C-MRI disclosed left occipitotemporal meningoencephalitis with subdural abscesses. Intravenous ceftriaxone was administered for 3 weeks. His condition gradually improved, with resorbed lesions detected on repeat MRI. This study expanded the clinical and imaging spectra of S. pneumoniae meningitis. In healthy adults, S. pneumoniae can invade the brain, but subdural abscess is a rare neuroimaging manifestation. Early diagnosis of S. pneumoniae meningitis by high-throughput sequencing and flexible treatment strategies are necessary for satisfactory outcomes.

Corticospinal Circuits from the Sensory and Motor Cortices Differentially Regulate Skilled Movements through Distinct Spinal Interneurons

Transcranial magnetic stimulation was performed on 25 patients with definite multiple sclerosis. Motor evoked potentials were recorded from the anterior tibial muscle. Central motor conduction time was calculated using the equation (F + M-1)/2 by stimulation of the common peroneal nerve. Motor evoked potentials were capable of detecting subclinical pyramidal tract lesions in multiple sclerosis. In patients with multiple sclerosis, the incidence of abnormality of motor and somatosensory evoked potentials was similar. Central motor conduction time was correlated with overall and pyramidal tract subscores on the Kurtzke Disability Status Scale and the Scripps Neurological Rating Scale. Central motor conduction time abnormalities correlated best with the presence of a Babinski's sign but also correlated significantly with weakness and hyperreflexia.

Contribution of Corticospinal Tract Damage to Cortical Motor Reorganization after a Single Clinical Attack of Multiple Sclerosis

Event Abstract Back to Event Technical and functional validations of High Angular Resolution Diffusion Imaging (HARDI)-MR tractography in paediatric epilepsy patients Sarah M. Barton1*, Joseph Y. Yang2, Wirginia Maixner2, A. Simon Harvey3, 4, Jeremy Freeman3, Richard Beare1, Marc Seal1, 4 and Vicki Anderson4, 5, 6 1 Murdoch Childrens Research Institute, Developmental Imaging, Australia 2 The Royal Children’s Hospital, Department of Neurosurgery, Australia 3 The Royal Children’s Hospital, Department of Neurology, Australia 4 The University of Melbourne, Department of Paediatrics, Australia 5 Murdoch Childrens Research Institute, Child Neuropsychology, Australia 6 The University of Melbourne, School of Psychological Sciences, Australia Background: HARDI-MR tractography is a neuroimaging technique that allows modelling of white matter tracts in the brain. The ability to visualise white matter tracts pre-operatively has the potential to improve neurosurgery accuracy and outcome. However despite its growing popularity, questions remain regarding its technical reproducibility and validity in routine clinical use. Here we examine the reliability of a locally practised HARDI-MR tractography method in paediatric epilepsy patients and in a novel demonstration present the functional validation of the technique against multimodal clinical investigations. Methods: Eight patients were identified retrospectively from our Children’s Epilepsy Program database. All cases had pre-operative diffusion MRI sequences and motor and/or language functional MRI (fMRI). In select cases, intra- or extra-operative motor and/or language cortical mapping results were available. Corticospinal (CST) and superior longitudinal fasciculus (SLF) tracts were generated by two different operators. Coefficients of variation (CV), intra-class correlation coefficients (ICC) and dice similarity coefficients (DSC) were calculated to assess reproducibility of tract metrics and degree of tract overlap between the operators. Tractography results were compared to fMRI activation, cortical mapping results and the patient’s clinical assessment findings. Results: All white matter tracts generated were visually comparable between operators. The tract measures showed low CV values, high ICC values and high DSC scores, indicating there was a high degree of reproducibility and overlap within and between the two operators. Cortical origin and terminations of all CST and SLF tracts matched with the patient’s areas of motor or language fMRI activation. In all but one case, tractography results matched cortical stimulation findings. Tracts were also compatible with the clinical assessment findings. Discussion: In a group of paediatric epilepsy patients, tractography results could be reliably generated and reproduced. In a novel demonstration, there was correspondence between the anatomical course of the tracts with areas of fMRI activation and, in all but one case, cortical stimulation findings. This suggests that in experienced hands, HARDI-MR tractography can be a reliable and valid technique in clinical settings. HARDI-MR tractography has the potential to make valuable contributions to neurosurgery planning to improve outcome for patients. Keywords: tractography, corticospinal tract, Superior longitudinal fasciculus, Paediatric, Epilepsy, Neurosurgery, diffusion imaging Conference: ACNS-2013 Australasian Cognitive Neuroscience Society Conference, Clayton, Melbourne, Australia, 28 Nov - 1 Dec, 2013. Presentation Type: Poster Topic: Other Citation: Barton SM, Yang JY, Maixner W, Harvey A, Freeman J, Beare R, Seal M and Anderson V (2013). Technical and functional validations of High Angular Resolution Diffusion Imaging (HARDI)-MR tractography in paediatric epilepsy patients. Conference Abstract: ACNS-2013 Australasian Cognitive Neuroscience Society Conference. doi: 10.3389/conf.fnhum.2013.212.00059 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 15 Oct 2013; Published Online: 25 Nov 2013. * Correspondence: Dr. Sarah M Barton, Murdoch Childrens Research Institute, Developmental Imaging, Parkville, Victoria, Australia, sarah.barton@mcri.edu.au Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Sarah M Barton Joseph Y Yang Wirginia Maixner A. Simon Harvey Jeremy Freeman Richard Beare Marc Seal Vicki Anderson Google Sarah M Barton Joseph Y Yang Wirginia Maixner A. Simon Harvey Jeremy Freeman Richard Beare Marc Seal Vicki Anderson Google Scholar Sarah M Barton Joseph Y Yang Wirginia Maixner A. Simon Harvey Jeremy Freeman Richard Beare Marc Seal Vicki Anderson PubMed Sarah M Barton Joseph Y Yang Wirginia Maixner A. 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