Foot-dipping in coma: a physical sign indicative of evolving herniation.
OBJECTIVE
Intermittent spontaneous recurrent foot movement characterized by sudden ankle dorsiflexion followed by slower relaxation, termed foot-dipping (FD), may occur in coma. The clinical significance of this easily overlooked sign is unknown.


METHODS
Twenty-three cases were identified by a single observer over a 10-year period of predominant inpatient neurologic care. Details of neurologic examination, clinical outcome, and CT and/or MRI findings were collected and analyzed.


RESULTS
All 23 patients presented with either an acute supratentorial vascular lesion accompanied by a midline brain shift (Group I, 12 cases) or a primary brainstem or cerebellar insult (Group II, 11 cases). FD in Group I patients was observed transiently only during evolving transtentorial herniation manifested by coma and partial brainstem areflexia.


CONCLUSIONS
The onset of FD in patients with acute supratentorial vascular lesion is indicative of a transtentorial herniation with secondary brainstem encroachment.
Chang
Gregory Youngnam
GY
Department of Neurology, University of California at Irvine Medical Center, Orange, Calif., USA. gychang00@gmail.com
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003128:Coma / Q000150:complications* / Q000473:pathology; D016208:Databases, Factual / Q000706:statistics & numerical data; D005260:Female; D005528:Foot / Q000503:physiopathology*; D006547:Hernia / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000150:complications*; D009460:Neurologic Examination / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult