• Amanda L Hernandez, Nicholas A Blondin, Gioacchino Curiale, and David M Greer.
• Yale University School of Medicine, P.O. Box 208018, New Haven, CT 06520, USA. amanda.hernandez@yale.edu
• Neurocrit Care. 2012 Oct 1;17(2):268-70.

BackgroundPlantar 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.MethodsCase report with Technetium-99 m hexamethylpropyleneamine oxime brain scan and video.ResultsA 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.ConclusionsNoxious stimulation to the dorsal surface of the foot may trigger spinally mediated plantar flexion in patients with brain death.

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