Spontaneous triple flexion response following acute pontine infarct
A 79-year-old man presented with dense left hemiparesis, left upper motor neuron facial weakness and dysarthria. Shortly after admission, he developed stereotyped left leg movements characterised by hip and knee flexion, ankle dorsiflexion and great toe extension, which persisted intermittently for 2 weeks (see figure 1). These movements occurred spontaneously and could also be elicited by plantar stimulation. We identified these involuntary movements as a spontaneous triple flexion response based on their stereotyped pattern, reproducibility and resemblance to Babinski’s early descriptions.1
The initial CT scan of the head and the CT cerebral angiogram (stroke protocol) were unremarkable. MR imaging of the brain, performed 3 weeks after symptom onset, showed a right ventral pontine subacute infarct involving the pyramidal tract (figure 2), likely caused by occlusion of a pontine paramedian perforating branch of the basilar artery in the context of known hypertension and smoking history. Electroencephalography captured the...
Source: Practical Neurology - Online First Published 26 Oct 2026 Imported 26 Oct 2026 Relevancy: Not reviewed
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