Background:Intracranial cause of isolated unilateral foot drop is very rare. There may be a delay in the diagnosis of the cause of central foot drop or patients with such lesions might be misdiagnosed and subjected to unnecessary interventions. One of the reasons for the diagnostic uncertainty might be the absence of upper motor neuron (UMN) signs in the initial examination of such patients.Case Description:We present a very rare case of a 78-year-old woman who had presented with a five-year progressive right-sided unilateral isolated foot drop from a left-sided parasagittal tumor. Previously, she had undergone biopsy of an abnormality on the right C7/T1 facet, which was found to be benign. On examination of the patient, she had UMN signs in the ipsilateral foot. On magnetic resonance imaging scan of her head, a 3-cm left parasagittal lesion, consistent with it being a meningioma, was noted. The patient had significant medical history and declined to undergo surgical removal of the lesion.Conclusion:We review the literature on central foot drop from various intracranial pathologies and discern its clinical features. Patients with central foot drop often have UMN signs; however, these may be absent causing diagnostic uncertainty, and physicians should be vigilant of these variations in the presentation.

We found that tailoring FMD for patients with CM-1 using intra-operative findings using ultrasound scan was useful in avoiding unnecessary manoeuvres, while not compromising on the outcome.

T o improve the quality of neurosurgical care and produce reliable clinical research, it is necessary for neurosurgeons to collect data on patient characteristics, processes of care, and clinically meaningful outcomes, to analyze these data, and to make the analysis available to individual neurosurgeons and the neurosurgical community. This is the Science of Practice algorithm. This issue of Neurosurgical Focus addresses the evolution of the Science of Practice and how it contributes to quality improvement now and how it will expand our opportunities for clinical research in the near future.We have lived our professional lives in the era of evidence-based medicine. However, despite multiple randomized trials, numerous guideline documents, and many millions of dollars spent, we still have not been able to reach consensus on the best management for many of our neurosurgical patients. Is this because neurosurgeons are simply recalcitrant and unwilling to be convinced by data, or because the constraints of randomized trials make neurosurgeons appropriately wary of applying their conclusions to their patients? Often, it is the latter. The Science of Practice approach to quality improvement and clinical research in neurosurgery will help to address this problem by generating real-world data that neurosurgeons can accept as applicable to the management of their patients. We believe that the Science of Practice will become an ever more important aspect of evidence-based medicine.The authors have been involved in clinical research and evidence-based medicine for many years and have

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