What grade of reflex is described as "very brisk, hyperactive with clonus"?

The description of "very brisk, hyperactive with clonus" aligns with a grade of reflex that indicates a significant level of excitability in the nervous system. This is characteristic of a hyperactive reflex, which is often assessed in the context of neurological examinations.

A reflex graded as "4" suggests that it is not only brisk but also associated with clonus, which is a rhythmic, involuntary contraction and relaxation of a muscle, indicating a heightened state of neurological response. This level of reflex activity often signifies the presence of upper motor neuron lesions or other pathologies within the central nervous system.

In contrast, lower grades of reflex (such as diminished or average) do not reflect the same level of activity and do not indicate the same underlying neurological concerns. Thus, the grading system for reflexes serves to categorize the degree of response observed during testing, with grade 4 representing the most pronounced and clinically significant reflex activity.