Babinski reflex by sural stimulation and dysfunction of descending motor pathway.

The aim of the study was to find out the relationship between the Babinski reflex and flexor polysynaptic reflexes which was evaluated by sural nerve stimulation, and to evaluate the descending motor pathway in involvement by cervical and transcortical cranial stimulation (TCCS) in a group of patients that were diagnosed as having the Babinski sign with either hemiparetic of hemiplegic, due to a cerebrovascular accident. In the normal population no significant responses were seen from the EHL by sural stimulation and these responses were recorded from the BF with a latency of 88 msec. In the patients who had Babinski reflex responses, signs could be easily recorded from EHL by sural stimulation with a latency of 166 msec. In this group, reflex responses from the BF were recorded with a latency of approximately 100 msec. Responses from the EHL were evaluated in 100% ratio by TCCS with a latency of 33.4 msec. in the normal group. The responses recorded from EHL by TCCS and latency was 47.5 msec. in 35.7% of the patients, who having Babinski sign. In 100% of the normal population, responses were evaluated with a latency of 28.8 msec. from EHL by cervical stimulation. In only 55% of the patients having the Babinski sign, responses were recorded in the same limb with a latency was 32.3 msec. These results support a different mechanism that control the EHL muscle in comparison to the BF muscle having dysfunction of descending motor tracts due to a pyramidal lesion.

Persistent primitive proatlantal intersegmental artery (proatlantal artery I) results in 'top of the basilar' syndrome.

BACKGROUND: Persistent primitive proatlantal intersegmental artery (proatlantal artery I) is an anastomotic channel between the carotid and vertebrobasilar arterial systems. Persistence of this embryonic anastomosis is very rare. The "top of the basilar" syndrome is usually due to occlusion of thalamoperforating arteries by emboli that rise from the vertebrobasilar arterial system. In this case, however, the emboli stemmed from atherosclerotic plaques in the carotid system. CASE DESCRIPTION: A 55-year-old woman was hospitalized with top of the basilar syndrome. A brain scan showed hypodense lesions extending from the mesencephalon to both thalami. Digital subtraction angiography of the cerebral circulation was performed, which revealed a proatlantal artery I on the left side. In addition, atheromatous plaques were seen along the internal and common carotid arteries on the same side. CONCLUSIONS: The occurrence of proatlantal artery I is extremely rare. Top of the basilar syndrome is also rarely encountered. To our knowledge, this is the first report of a patient with both conditions.