Abnormal pyramidal sign Oppenheim reflex This reflex can indicate affection of the corticospinal (pyramidal) tracts. Dorsiflexion of the big toe, sometimes accompanied by fanning of the other toes, elicited by stroking along the medial side of the tibia (the normal response would be no movement of the big toe). Oppenheim sign UMLS:C1532837 SNOMEDCT_US:414949005