title: Plantar flexion with noxious dorsal foot stimulation in brain death.
abstract: BACKGROUND
  Plantar flexion with plantar stimulation has been well described in brain death, and is compatible with brain death. However, plantar flexion with stimulation to the dorsal surface of the foot has not been reported previously in brain dead patients.
  
  
  METHODS
  Case report with Technetium-99 m hexamethylpropyleneamine oxime brain scan and video.
  
  
  RESULTS
  A 46-year-old woman suffered severe anoxic brain injury following massive pulmonary embolism 5 days after arthroscopic knee surgery. Neurologic examination was consistent with brain death, with the exception of plantar flexion when noxious stimulation was applied to the dorsal surface of the great toe on each side. Ancillary testing with a technetium-99 m nuclear scan demonstrated absence of cerebral perfusion, supporting the diagnosis of brain death.
  
  
  CONCLUSIONS
  Noxious stimulation to the dorsal surface of the foot may trigger spinally mediated plantar flexion in patients with brain death.
authors.affiliation: Yale University School of Medicine, P.O. Box 208018, New Haven, CT 06520, USA. amanda.hernandez@yale.edu
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Hernandez
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Blondin
authors.forename: Gioacchino
authors.initials: G
authors.lastname: Curiale
authors.forename: David M
authors.initials: DM
authors.lastname: Greer
mesh_terms: D001926:Brain Death / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D005528:Foot; D006801:Humans; D002534:Hypoxia, Brain / Q000000981:diagnostic imaging / Q000209:etiology; D008875:Middle Aged; D055420:Perfusion Imaging; D011655:Pulmonary Embolism / Q000150:complications; D019275:Radiopharmaceuticals; D012018:Reflex; D013116:Spinal Cord; D013667:Technetium
chemical_list: D019275:Radiopharmaceuticals; D013667:Technetium