Foot dipping in coma
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To the Editor: I enjoyed the article by Hanna and Frank.1 They described two patients who had spontaneous alternating flexion of the hip, knee, and ankle during herniation with clinical localization at the level of lower brainstem.
They termed this movement "automatic stepping" and suggested the spinal cord as the generator. I recently observed a similar phenomenon with automatic spontaneous alternating movement restricted to foot joints.
A 49-year-old woman with diagnosis of coccidiomycosis meningitis, after VP shunt, was admitted for her routine cisternal injection of amphotericin. Shortly after admission she had cardiac arrythmia followed by marked stupor. Neurologic examination showed she was unresponsive, with enlarged fixed pupils and absent corneal, doll's and ice-water calorics. Pain stimulation resulted in limited withdrawal motor response restricted to the lower extremity consistent with triple flexion response. Further …
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