The Babinski sign is a fairly reliable indicator of corticospinal tract (CST) dysfunction, the upper motor neurons that connect the cortex of the brain (and our will) to the spinal cord. But it is not infallible. Occasionally, it may be unfairly positive, especially in infants. It also may be ordinary (upgoing toe) when there is impulsive or incomplete CST disease.
It is a good bedside trial for damage to the CST, the tract of upper motor neurons descending from the brain's cortex to the spinal cord. After a stroke, for example, stroking the sole of he foot may let go a downward pointing big toe (hallux), a sign of brain damage on the contralateral (other) side of the brain.
It is usually reliable when positive, but, as stated, it is not infallible. A positive Babinski examination should be followed up with more precise studies, such as MRI. A unenthusiastic test should not prevent such an evaluation if it is otherwise indicated.
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