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. Conclusion: The onset of FD in patients with acute supratentorial vascular lesion is indicative of a transtentorial herniation with secondary brainstem encroachment.

Keywords:
Brainstem encroachment, Foot-dipping, Herniation
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© 2010 S. Karger AG, Basel
2010
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