Bilateral Central Foot Drop in a Pediatric Patient

Abstract

Foot drop is an inability to dorsiflex the ankle and toe. Primary causes of foot drop are compression or lesion of the 5th lumbar nerve and entrapment of the peroneal nerve at the head of the fibula. Rarely, some central nervous system lesions lead to foot drop. A 16-year-old boy was admitted with blunt head trauma that had happened in an assault. The muscle strength of the bilateral tibialis anterior, bilateral extensor digitorum longus and bilateral extensor digitorum brevis were Medical Research Council grade 1. Deep tendon reflexes of both ankles were hyperactive, with bilateral clonus and bilateral Babinski sign. There were cerebral contusions with peripheral edema in both motor strip areas extending anteriorly into the frontal lobes, with right-sided epidural-subdural hematoma. On brain MRI, the superior sagittal sinus was open. The epidural-subdural hematoma did not progress in its dimensions. The patient was treated conservatively. He recovered fully with regression of the contusions and epidural-subdural hematoma 4 months after the trauma. Foot drop due to upper motor neuron pathologies is more spastic in nature, different from what happens following lumbar disc herniation or peroneal nerve dysfunction. Treatment of central foot drop should be planned according to the underlying pathology.

Second ever reported case of central cause of unilateral foot drop due to cervical disc herniation: Case report and review of literature

“…Most of the published FD cases due to central etiologies are due to brain lesions, including cerebral infarction, intra-cranial tumor, traumatic brain injury and multiple sclerosis [ 5 , 8 ]. Some articles reported that thoracic spine disc protrusion cases with FD could be due to UMNL [ [14] , [15] , [16] ].…”

“…To the best of our knowledge, in terms of central cervical etiology of FD, only one case of unilateral FD caused by a cervical spine lesion has been reported to date [ 3 ]. Central etiologies of FD are due to brain lesions [ 5 , 8 ].…”

Acute bilateral foot drop with or without cauda equina syndrome—a case series

“…Reports of traumatic brain injury, and an anterior communicating artery intracranial aneurysm, presenting with acute bilateral foot drop highlight the need to exclude cranial/ central causes when no other pathology can be found [14,28,34]. Both the brain and spinal cord could be the source of the presentation due to specific vascular, neoplastic, infective, or demyelinating lesions.…”