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.
ObjectiveThis study analyzed retrospectively the bladder function of patients after early surgery for cauda equina syndrome (CES) performed within 24 or 48 hours, or after 48 hours of the onset of autonomic symptoms.MethodsWe retrospectively reviewed the clinical data of 31 patients after decompression surgery for lumbar disc herniation (LDH) who had been diagnosed with CES between January 2001 and December 2014 at Inha University Hospital. The following factors were assessed to evaluate the influence of time to surgery: bladder function, rectal incontinence, sexual dysfunction, LDH level, and degree of spinal canal compression.ResultsAfter decompression, the outcome group was categorized into normal bladder function and abnormal bladder function. The patients operated on within 48 hours showed an improved postoperative outcome. Among 16 patients operated on within 48 hours, 13 (81%) recovered normal bladder function. In contrast, among 15 patients with decompression after 48 hours, 6 (40%) recovered normal bladder function. Among 21 patients with mild bladder dysfunction at admission, 16 (76%) recovered normal bladder function after decompression.ConclusionOur study suggests that patients who have decompression surgery within 48 hours of the onset of bladder dysfunction, improve their chances of recovering bladder function than those who have a late operation (>48 hours). Also, patients with mild bladder dysfunction are more likely to recover bladder function after decompression, than patients with severe bladder dysfunction.
Objective:The goal of this retrospective study was to assess clinical and radiographic outcomes of posterior surgical decompression with stabilization followed by image-guided robot Cyberknife radiosurgery for encircling malignant tumors of the spine. Methods: From August 2008 to December 2009, 14 consecutive patients with a malignant spinal metastatic lesion with cord compression were treated at the author's institute. Patients underwent on a decompressive surgery by the posterior approach, and latent unstable spines were stabilized with instrumentation. After recovery, radiosurgery was administered at doses ranging from 16 to 26 Gy (mean 20.1 Gy) prescribed to the 75-85% isodose line that encompassed at least 95% of tumor volumes. Visual Analogue Scale, American spine injury association grades, and MRI with gadolinium enhancement were used to monitor pain, neurology, and radiological outcomes, respectively, after the radiosurgery. Results: No acute radiation-induced toxicity or new neurological deficit occurred during the follow-up period (mean 4.5 months). Axial pain improved in 10 out of the 14 patients. No hardware failure was encountered. At 3-6 months after the Cyberknife radiosurgery, local control and effective therapeutic rates were both 80% (8/10) and no lesion enhancement on vertebral bodies or pedicles was visualized by MRI. Conclusion: Posterior decompression with stabilization followed by radiosurgery of residual tumor in the anterolateral region is useful in cases where an anterior approach or a circumferential approach is not an option due to medical condition. Longer term follow-up is required to evaluate survival and late toxicities.
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