Shields Lisa B E, Iyer Vasudeva G, Zhang Yi Ping, Shields Christopher B
1Norton Neuroscience Institute, Norton Healthcare, Louisville, Kentucky.
2Neurodiagnostic Center of Louisville, Louisville, Kentucky; and.
J Neurosurg Case Lessons. 2023 May 22;5(21). doi: 10.3171/CASE23154.
Differentiating foot drop due to upper motor neuron (UMN) lesions from that due to lower motor neuron lesions is crucial to avoid unnecessary surgery or surgery at the wrong location. Electrodiagnostic (EDX) studies are useful in evaluating patients with spastic foot drop (SFD).
Among 16 patients with SFD, the cause was cervical myelopathy in 5 patients (31%), cerebrovascular accident in 3 (18%), hereditary spastic paraplegia in 2 (12%), multiple sclerosis in 2 (12%), chronic cerebral small vessel disease in 2 (12%), intracranial meningioma in 1 (6%), and diffuse brain injury in 1 (6%). Twelve patients (75%) had weakness of a single leg, whereas 2 others (12%) had bilateral weakness. Eleven patients (69%) had difficulty walking. The deep tendon reflexes of the legs were hyperactive in 15 patients (94%), with an extensor plantar response in 9 patients (56%). Twelve patients (75%) had normal motor and sensory conduction, 11 of whom had no denervation changes of the legs.
This study is intended to raise awareness among surgeons about the clinical features of SFD. EDX studies are valuable in ruling out peripheral causes of foot drop, which encourages diagnostic investigation into a UMN source for the foot drop.
区分上运动神经元（UMN）损伤所致足下垂与下运动神经元损伤所致足下垂对于避免不必要的手术或错误部位的手术至关重要。电诊断（EDX）研究有助于评估痉挛性足下垂（SFD）患者。
在16例SFD患者中，病因包括颈椎病5例（31%）、脑血管意外3例（18%）、遗传性痉挛性截瘫2例（12%）、多发性硬化2例（12%）、慢性脑小血管病2例（12%）、颅内脑膜瘤1例（6%）、弥漫性脑损伤1例（6%）。12例患者（75%）单腿无力，另外2例（12%）双腿无力。11例患者（69%）行走困难。15例患者（94%）下肢深腱反射亢进，9例患者（56%）出现跖伸反应。12例患者（75%）运动和感觉传导正常，其中11例下肢无失神经改变。
本研究旨在提高外科医生对SFD临床特征的认识。EDX研究对于排除足下垂的外周病因很有价值，这有助于针对足下垂的UMN病因进行诊断性检查。
