Acute bilateral isolated foot drop: Report of two cases

Area of Science:

• Neurology
• Neurosurgery
• Spinal Disorders

Background:

• Foot drop, characterized by weakness in foot and ankle dorsiflexion, is typically unilateral and acute.
• Bilateral foot drop is uncommon, with slowly progressing forms linked to metabolic issues, intracranial pathologies, or cauda equina syndrome.
• Acute bilateral foot drop from disc herniation is exceptionally rare.

Observation:

• Two male patients presented with acute bilateral foot drop.
• The first patient, 45, had L4-L5 disc herniation without cauda equina syndrome symptoms.
• The second patient, 50, had a T12-L1 disc herniation with intradural extension.

Findings:

• This study presents the first documented cases of acute bilateral foot drop caused by L4-L5 disc herniation (without cauda equina syndrome) and T12-L1 disc herniation with intradural extension.
• Both patients underwent emergent decompressive laminectomy for excision of herniated disc material.
• Surgical intervention resulted in favorable outcomes for both individuals.

Implications:

• Disc herniation should be considered in the differential diagnosis of acute bilateral foot drop, even in the absence of typical cauda equina syndrome.
• Prompt surgical decompression can lead to significant recovery in patients with acute bilateral foot drop secondary to disc herniation.
• These findings expand the understanding of rare spinal pathologies presenting with bilateral foot drop.