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. 2017 Dec;7(6):483-487.
doi: 10.1212/CPJ.0000000000000398.

The upgoing thumb sign: An interobserver/intraobserver reliability study

Shahram Abootalebi  1 , Mahmoud Reza Azarpazhooh  1 , Luciano Sposato  1 , Vladimir Hachinski  1
Affiliations

The upgoing thumb sign: An interobserver/intraobserver reliability study

Shahram Abootalebi et al. Neurol Clin Pract. 2017 Dec.

Abstract

Background: The upgoing thumb sign as a subtle clinical finding of upper motor neuron involvement has been frequently reported in patients with TIAs and minor strokes. This study was designed to show the method of examination and interpretation and the interobserver/intraobserver reliability.

Methods: The thumb sign was elicited in TIA/minor strokes or stroke mimics. After obtaining the participant's permission, the examinations were recorded. Two independent neurologists reviewed all patients for the possibility of an upgoing thumb sign. After 1 hour education about the definition of an upgoing thumb sign to a group of stroke fellows, nurse practitioners, and a research secretary, the videos were reviewed and the participants rated the thumb sign independently. The intraobserver reliability was assessed after 3 months by rating the same videos.

Results: The interobserver reliability among 9 raters showed an overall agreement of 0.83 and fixed-marginal kappa of 0.66. The same videos were reviewed by the observers after 3 months with a similar level of agreement (percent of overall agreement 0.84, fixed-marginal kappa 0.66) and a substantial to almost perfect level of intraobserver concordance (mean 0.86; SD 0.08; median 0.90; interquartile range 25-75, 0.8, 0.95).

Conclusions: The upgoing thumb sign is a subtle upper limb neurologic finding, with a high level of interobserver and intraobserver reliability. The test is easy to perform and can be interpreted accurately.

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Figures

Figure 1
Figure 1. Left upgoing thumb sign in a patient with a history of TIA
Figure 2
Figure 2. Intraobserver reliability of the thumb sign after 3 months among 9 independent observers
See this image and copyright information in PMC

References

    1. Hachinski V, Norris JW. The Acute Stroke. Philadelphia: FA Davis; 1985.
    1. Hachinski V. The upgoing thumb sign. Arch Neurol 1992;49:346. - PubMed
    1. Nucera A, Azarpazhooh MR, Cardinali L, Alsubai R, Chiang TC, Weishaupt N, Hachinski V. Inhibition of the primary motor cortex and the upgoing thumb sign. ENeurologialSci (eNS) 2017;8:31–33. - PMC - PubMed
    1. Souques AA. Sur le “phénomène des interosseux” de la main ou “phénomène des doigt” dans l’hémiplégie organique. Bull Mem Soc Med Hop Paris 1906;24:677.
    1. Alter M. The digiti quinti sign of mild hemiparesis. Neurology 1973;23:503–505. - PubMed

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