Narenthiran Ganesalingam, Leach Paul, Holland Jeremy P
Department of Neurosurgery, Wessex Neurological Centre, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom.
Surg Neurol Int. 2011 Mar 14;2:27. doi: 10.4103/2152-7806.77594.
Intracranial cause of isolated unilateral foot drop is very rare. There may be a delay in the diagnosis of the cause of central foot drop or patients with such lesions might be misdiagnosed and subjected to unnecessary interventions. One of the reasons for the diagnostic uncertainty might be the absence of upper motor neuron (UMN) signs in the initial examination of such patients.
We present a very rare case of a 78-year-old woman who had presented with a five-year progressive right-sided unilateral isolated foot drop from a left-sided parasagittal tumor. Previously, she had undergone biopsy of an abnormality on the right C7/T1 facet, which was found to be benign. On examination of the patient, she had UMN signs in the ipsilateral foot. On magnetic resonance imaging scan of her head, a 3-cm left parasagittal lesion, consistent with it being a meningioma, was noted. The patient had significant medical history and declined to undergo surgical removal of the lesion.
We review the literature on central foot drop from various intracranial pathologies and discern its clinical features. Patients with central foot drop often have UMN signs; however, these may be absent causing diagnostic uncertainty, and physicians should be vigilant of these variations in the presentation.
孤立性单侧足下垂的颅内病因非常罕见。中枢性足下垂病因的诊断可能会延迟，或者患有此类病变的患者可能会被误诊并接受不必要的干预。诊断不确定性的原因之一可能是此类患者在初始检查时缺乏上运动神经元（UMN）体征。
我们报告一例非常罕见的病例，一名78岁女性因左侧矢状旁肿瘤出现进行性右侧单侧孤立性足下垂5年。此前，她接受了右侧C7/T1关节面异常的活检，结果为良性。对该患者进行检查时，其同侧足部有UMN体征。在她的头部磁共振成像扫描中，发现一个3厘米的左侧矢状旁病变，符合脑膜瘤表现。该患者有显著的病史，拒绝接受手术切除病变。
我们回顾了关于各种颅内病变导致中枢性足下垂的文献，并识别其临床特征。中枢性足下垂患者通常有UMN体征；然而，这些体征可能不存在，导致诊断存在不确定性，医生应警惕这些临床表现的差异。
