Acute foot drop syndrome mimicking peroneal nerve injury: an atypical presentation of ischemic stroke

Diagnostic Challenges in Outpatient Stroke: Stroke Chameleons and Atypical Stroke Syndromes

Failure to diagnose transient ischemic attack (TIA) or stroke in a timely fashion is associated with significant patient morbidity and mortality. In the outpatient or clinic setting, we suspect that patients with minor, transient, and atypical manifestations of cerebrovascular disease are most prone to missed or delayed diagnosis. We therefore detail common stroke chameleon symptoms as well as atypical stroke presentations, broadly review new developments in the study of diagnostic error in the outpatient setting, suggest practical clinical strategies for diagnostic error reduction, and emphasize the need for rapid consultation of stroke specialists when appropriate. We also address the role of psychiatric disease and vascular risk factors in the diagnostic evaluation and treatment of suspected stroke/TIA patients. We advocate incorporating diagnostic time-outs into clinical practice to assure that the diagnosis of TIA or stroke is considered in all relevant patient encounters after a detailed history and examination are conducted in the outpatient setting.

Cortical foot

An 83-year-old woman presented with an acute onset of foot drop. Whilst the pattern of weakness initially appeared to be most likely due to a peripheral cause, an MR scan of the brain showed a small cortical stroke. This rare phenomenon appears similar to the more widely described 'cortical hand'.

Clinching the cause: A review of foot drop secondary to lumbar degenerative diseases

Foot drop is defined as weakness on dorsiflexion of the foot. The top two most common etiologies for foot drop include lumbar degenerative disease and common peroneal nerve injury. This review provides "updates" on understanding the lumbar etiologies of foot drop. Since the publication of "Preoperative motor strength and time to surgery are the most important predictors of improvement in foot drop due to degenerative lumbar disease" in the Journal of Neurological Sciences, three cohort studies have been published on spinal causes of foot drop. Classification, clinical features, diagnosis, and pathogenesis that may 'clinch' the cause of foot drop are discussed in the context of these recent publications.

CT-negative, MRI GRE-positive primary motor cortex contusion causing isolated foot drop

Background:

Isolated acute foot drop due to traumatic brain injury is exceedingly rare and is often misdiagnosed during initial evaluation. Here, we present the case of a patient who presented with left foot drop after falling off a bicycle.

Case Description:

The patient is a 55-year-old male who was mountain biking when he fell, hit his head, and lost consciousness. Neurologic examination of the left leg revealed foot drop, no sensory deficits, and 3+ reflexes at the knee and ankle with clonus. Electroencephalography, computed tomography (CT) of the head, magnetic resonance imaging (MRI) of the lumbar spine, and CT of the lower extremities were all negative. Only MRI of the brain with a gradient echo sequence revealed microhemorrhages focused around the right precentral gyrus. The patient underwent physical therapy, and by 3 months had regained full strength in his left leg.

Conclusion:

Central causes of foot drop are exceptionally rare, however, they should be considered in all cases of post-traumatic dorsiflexion paresis. The key to the accurate diagnosis is a high index of suspicion as well as thorough and careful physical examination including reflex and sensory testing. Selective imaging modalities such as MRI or CT can then be used to verify the diagnosis.

Isolated Painless Foot Drop due to Cerebral Infarction Mimicking Lumbar Radiculopathy: A Case Report

Although they usually originate from peripheral problems, foot drop is caused by lesions affecting the neural pathway related to dorsiflexor muscles, whether of central or peripheral origin. We present a patient with sudden isolated foot drop caused by a small infarct in the primary motor cortex mimicking a peripheral origin. This report indicates that patients presenting isolated foot drop should be managed carefully and the possibility of both central and peripheral causes should be considered. To our knowledge, this is the first report of sudden isolated foot drop caused by a cortical infarction mimicking lumbar radiculopathy.