Bilateral foot drop in a young woman
- PDF / 443,888 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 83 Downloads / 198 Views
NEURO-IMAGES
Bilateral foot drop in a young woman Mohd Syahrul Nizam Ag Lamat1 · Ching Soong Khoo1 · Fatin Shaaya2 Received: 12 May 2020 / Accepted: 3 July 2020 © Belgian Neurological Society 2020
A 29-year-old previously healthy woman presented with a 5-year history of progressive bilateral foot drop. She reported no sensory complaints and there was no history of spinal or leg injury. No family history of neurological disorders was elicited. On examination, she was fully conscious with stable vital signs. Neurological assessment revealed high-arched feet and a high stepping gait. The muscle power of the left and right foot dorsiflexion was 0/5 and 2/5, respectively. Deep tendon reflexes were reduced in both legs. Sensation was intact. Neurological examination of her upper limbs and cranial nerves was unremarkable. Her laboratory tests were essentially normal. Electrophysiological studies (nerve conduction study and electromyogram) were suggestive of left common peroneal neuropathy and right deep peroneal neuropathy. Magnetic resonance imaging (MRI) of the thoracic and lumbosacral spines showed the following changes (Fig. 1). Lumbar puncture was not performed as she did not consent to it. Her bilateral foot drop was attributed to the extensive cysts in the lumbar spinal canal. There were multiple extramedullary locules of cysts along the lumbar region encasing the spinal cord and thecal sac with posterior vertebral scalloping, with the largest seen from the levels T12 to L1/2. These lesions were hypointense on T1WI, hyperintense on T2WI, and not suppressed on STIR sequences, which were in keeping with cystic fluid. They also caused foraminal and extra-foraminal herniations, seen worst at the L5/S1 level.
Foot drop occurs due to weakness of the dorsiflexors, which include mainly the tibialis anterior, extensor hallucis longus and extensor digitorum longus muscles. Causes of foot drop are manifold. Common peroneal nerve injury is the most common etiology of unilateral foot drop. Focal peroneal neuropathy can be associated with entrapment (for instance, compression at the level of the fibular head), trauma injuries, compartment syndrome, masses and tumors. Systemic diseases such as diabetes mellitus, vasculitis, leprosy and multifocal motor neuropathy are important causes too. L5 radiculopathy is another common etiology for foot drop, usually caused by lumbar disc herniation, lumbar degenerative disease and lumbar spinal stenosis with compression of the L4/L5 segments [1, 2]. Bilateral foot drop is relatively rare and occurs in various diseases such as inherited conditions like Charcot–Marie–Tooth disease, chronic inflammatory demyelinating polyneuropathy, central causes like parasagittal tumors, anorexia nervosa, hypothyroid myopathy, Crohn’s disease and post electroconvulsive therapy [2, 3]. Extensive cysts in the lumbar spinal canal causing bilateral foot drop, like in our case, to our knowledge, have never been reported. Our patient underwent posterior lumbar laminectomy, which resulted in clinical improvemen
Data Loading...