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An Unusual Presentation of Chronic Subdural Hematoma with Isolated Footdrop
Sarah D Weisberg1, John K Houten2
1Division of Neurosurgery, Maimonides Medical Center, Brooklyn, New York, USA.
Insights
Chronic subdural hematoma (CSDH) can rarely cause isolated foot weakness. Prompt surgical drainage of CSDH can resolve this unusual neurological symptom.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Chronic subdural hematoma (CSDH) commonly presents with symptoms of increased intracranial pressure or contralateral weakness.
- Motor deficits in CSDH typically affect the upper extremities more than the lower extremities.
- Isolated lower extremity weakness is an uncommon presentation of CSDH.
Background:
Patients with chronic subdural hematoma (CSDH) typically present with symptoms of increased intracranial pressure, including headache, nausea/vomiting, and somnolence, or with contralateral weakness. Compression of the convexity cerebral cortex usually causes motor deficit that is more readily appreciated in the upper extremity rather than in the leg, and very subtle deficit may be detected only by looking for pronator drift. The precise pattern of signs and symptoms in CSDH may vary from case to case depending on the specific anatomy of compression, but isolated lower extremity weakness is rare.
Case Description:
A 79-year-old woman presented with isolated footdrop. CSDH overlying the cerebral convexity was detected on computed tomography. The foot weakness resolved on surgical drainage.
Conclusions:
CSDH overlying the cerebral convexity may manifest with isolated foot weakness. Awareness of the potential for this unusual presentation of CSDH may be useful to the clinician assessing a patient with otherwise unexplained foot weakness.
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