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Brisk reflexes

Hi I have varying information on what brisk refelxes mean. This in me has never been picked up before, although having said that a 10 months after a car accident I had drop foot and clonus on my left side. I believe from what I have read clonus is related to brisk reflexes. Anyway, as a result of my last exam I am being sent for an MRI but only of the brain. I read this morning in the forum that brisk reflexes are indication of a spinal cord problem not brain. I hope I am not going to have a wasted journey, if they are not looking beyond the brain… any thoughts I don’t mind if they are conflicting…

Some people naturally have brisk reflexes and they’re probably looking at your brain first as a precautionary measure before looking elsewhere. Could be that you had the brisk reflexes before your history of a car accident, but only came to light now.

Only reason I can think of why they’re only looking at brain first… Hope that helps xx

I was diagnosed with ms in august. First I had a brain scan, then another brain scan with contrast ( shows if any active lesions). My neuro is a lovely man but I had to ask him to scan my spine…he wasn’t going to. I was concerned about problems with gait, incontinence and other things. Turns out I have a lesion on my spine. Don’t worry, its not a waste of time having the brain MRI…just be patient. See what the results are, you may want to discuss at your next neuro appointment about wanting a scan on your spine. Neurologist are not really keen on scanning the spine. I suppose if you think about the anatomy of the body, the spine is obviously not flat is it? The potential to miss things on the scan must be high. I have a lot of neck pain and it wouldn’t surprise me if I had a lesion there, buy hey ho I’ll never know. All the best to you, keep us up to date with how you get on.

I thought brisk reflexes were spine neuro problem but heard it can be someone’s normal or caused by stress (isn’t everything lol) Axx

I was informed by my GP that some people have brisk reflexes naturally. She does and was the scape goat for testing reflexes whilst studying medicine lol. So doesn’t always have to be caused by a spine neuro problem.

But you are right Arwen, stress causes everything lol xx

I was told my reflexes were a little brisk, and was sent for brain, cspine mri…

x

Hi Lou Lou x if your reflexes were brisk enough to be noted as abnormal and you had myoclonus then this indicates an upper motor neuron issue x

Neurologists are trained to distinguish between stress induced reflex responses and those that indicate abnormalities - I would query this with your specialist not your GP xxxjenxxx

Does anyone know what it means if they are brisker on one side than the other?

Generally - and I mean generally as MS doesn’t always follow the rules - symptoms and clinical signs tend to be on one side with MSers. I don’t know why.

With reflexes it’s the same - basically we should be more or less equal both sides!

They know a Positive Babinski response for example is caused by some structural abnormality somewhere along the upper spinal tract - or the cerebral cortex/brain stem area of the brain that controls it. Neuros see it in people who have had a stroke, or have a brain or spinal cord tumour – it can also be present when someone has metabolic abnormalities like hypoglycaemia. Thyroiod problems and hypoxia.

With MS it’s usually a lesion/inflammation/scarring somewhere in these areas

It basically shows that something is interfering with the body’s normal response to an external stimulus and of all the abnormal responses the abnormal Babinki response is the one that rings alarm bells with the neuros

Similarly but not so significant is hyperreflexia – for a neuro to tag it ‘abnormal’ depends on the degree of the response.

The response should always be ‘brisk’ and decent neuro knows just how much normal ‘kick’ he should expect with the ankle and knee taps.

There is a range where the response may be ‘more brisk’ but not significant – ie normal – he or she knows when the response is due to the person being stressed or anxious. He’s used to this and can tell a ‘purposeful’ response a mile off - if you know what I mean.

If the knee or ankle reflex is absent this is abnormal

If myoclonus is also present with very brisk response then it’s a lot more concerning - and again indicates a problem in the upper area of the spinal canal up to the brain

This is how they normally classify hyper or hypo reflexia

0 = no response; always abnormal

1+ = a slight but definitely present response; may or may not be normal

2+ = a brisk response; normal

3+ = a very brisk response; may or may not be normal

4+ = a tap elicits a repeating reflex (clonus); always abnormal

Remember - all this is not taken alone but added to any other abnormal things like your other reflexes, muscle tone, muscle strength etc

Also it’s really important to understand that things are not as simple as we think - when doing a neuro exam the neuro will be feeling/seeing/noting all sorts of other things when carrying these tests out – it’s much more complicated than we think!

With certain responses and the accompanying signs they can even actually pinpoint the exact position of the problem eg a lesion on C5 or C6!

That’s why GPs are only the first port of call – they have basic training to spot a possibly abnormal reflex response - but they are rarely trained or experienced enough with the rest!

Not sure if his helps!

xxxxJen xxx