Clinical Significance and Management of Babinski Sign

Indications of Pathology

Hepatic encephalopathy is associated with a positive Babinski sign, as part of the motor system abnormalities in non-comatose patients, according to the Journal of Hepatology 1, 2
Neuroleptic malignant syndrome can present with a Babinski sign as one of the less common neurologic signs, as reported in Pediatrics 3
Cerebral infarction with swelling can cause a Babinski sign to appear contralateral to hemiparesis due to brainstem compression, as noted in Stroke 4
Thoracic myelopathy or radiculopathy can result in a Babinski sign as a sign of upper motor neuron dysfunction, according to the Journal of the American College of Radiology 5
Genetic disorders such as 22q11.2 deletion syndrome-related conditions can be associated with a positive Babinski sign, as reported in Genetics in Medicine 6

The American College of Radiology recommends MRI of the brain or spinal cord as the preferred imaging modality when a positive Babinski sign is detected, with CT as an alternative if MRI is contraindicated 7
Neuroimaging is particularly indicated when the Babinski sign is accompanied by recent onset of cognitive symptoms, unexplained neurological manifestations, significant vascular risk factors, or symptoms of increased intracranial pressure 7

The European Association for the Study of the Liver suggests evaluating for other upper motor neuron signs, such as hyperreflexia, spasticity, and weakness, in patients with a positive Babinski sign 2, 8
The American Association for the Study of Liver Diseases recommends assessing for cognitive dysfunction, which may coexist with motor signs, in patients with hepatic encephalopathy 1, 2

The American Heart Association recommends standard stroke management protocols, including thrombolysis or thrombectomy if appropriate, for patients with a positive Babinski sign due to stroke 1, 8
The European Association for the Study of the Liver suggests ammonia-lowering therapies and management of precipitating factors for patients with hepatic encephalopathy and a positive Babinski sign 1, 8
The American College of Radiology recommends surgical decompression for structural causes of cord compression in patients with thoracic myelopathy and a positive Babinski sign 5