Foot-dipping in coma: a physical sign indicative of evolving herniation

Area of Science:

• Neurology
• Neuroscience
• Clinical Medicine

Background:

• Foot-dipping (FD) is an intermittent, spontaneous foot movement observed in comatose patients.
• The clinical significance of FD, characterized by ankle dorsiflexion and slow relaxation, remains largely unknown.

Purpose of the Study:

• To investigate the clinical significance of foot-dipping (FD) as a potential neurological sign.
• To determine the association between FD and specific neurological insults.

Main Methods:

• Retrospective analysis of 23 cases over 10 years.
• Detailed review of neurological examinations, clinical outcomes, and neuroimaging (CT/MRI).

Main Results:

• FD was observed in patients with acute supratentorial vascular lesions and midline shift (Group I) or primary brainstem/cerebellar insults (Group II).
• In Group I, FD occurred transiently during evolving transtentorial herniation, indicated by coma and partial brainstem areflexia.

Conclusions:

• The appearance of FD in patients with acute supratentorial vascular lesions signifies transtentorial herniation.
• FD indicates secondary brainstem encroachment, highlighting its importance as a clinical sign.