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CT-negative, MRI GRE-positive primary motor cortex contusion causing isolated foot drop.
Alexander M Tucker1, Tianyi Niu1, Daniel T Nagasawa1
1Department of Neurosurgery, University of California-Los Angeles, Los Angeles, California, USA.
Surgical Neurology International
|December 2, 2016
Summary
Isolated foot drop after head injury is rare but possible. Prompt diagnosis using brain MRI is key for rare central causes of traumatic foot drop.
Area of Science:
- Neurology
- Traumatology
Background:
- Isolated acute foot drop following traumatic brain injury (TBI) is rare.
- It is frequently misdiagnosed during initial patient evaluation.
Observation:
- A 55-year-old male experienced left foot drop after a bicycle accident and loss of consciousness.
- Neurological examination revealed foot drop, intact sensation, and hyperreflexia with clonus.
- Initial imaging (EEG, head CT, lumbar spine MRI, lower extremity CT) was negative.
Findings:
- Brain MRI with gradient echo sequence identified microhemorrhages near the right precentral gyrus.
- This finding indicated a central cause for the foot drop.
- The patient recovered full leg strength within 3 months with physical therapy.
Implications:
- Central causes of foot drop, though rare, must be considered in post-traumatic cases.
- A high index of suspicion and thorough physical examination are crucial for diagnosis.
- Selective imaging, particularly brain MRI, aids in confirming central etiologies.
