Acute bilateral foot drop due to lumbar disc herniation treated by bilateral interlaminar approach: case report and literature review.

Foot drop due to lumbar disc herniation (LDH) is a relatively common finding in spinal practice. Bilateral foot drop (BFD) due to LDH is an extremely rare condition with only a few reported cases. We describe the case of a middle-aged man presenting with a rapid onset BFD with back and leg pain. Urgent MRI revealed an L4-L5 centrally located LDH with bilateral compression of the L5 nerve roots and the cauda equina centrally. About 4 h after presentation surgery was performed adopting a bilateral L4-L5 interlaminar approach and the prolapsed disc was removed. Nine months after surgery, the patient showed a complete recovery of his deficit. We discuss the advantages of this approach in this urgent situation and we compare it with other techniques.

Evaluating Acute Bilateral Foot Drop: A Case Report.

We illustrate the case of an 84-year-old Caucasian female who presented with complaints of bilateral lower extremity weakness and ambulation difficulties complicated by a unilateral deep venous thrombosis. Physical examination on hospital admission revealed an acute onset of bilateral foot drop with pes cavus deformity. Bilateral foot drop has been associated with a more chronic presentation due to metabolic, neurologic, and musculoskeletal etiologies. Acute onset of bilateral foot drop has been poorly defined in the literature and is considered a rare pathologic phenomenon, requiring additional investigation into the underlying cause of the presentation. We hypothesize that a spinal cord compression at the T12-L1 level resulted in L5 nerve root compression, resulting in our patient's presentation. Definitive treatment has not been established for this condition; however, studies have been completed to evaluate surgical versus conservative approaches to help restore patients' ambulatory function. Our aim is to incorporate this case report into the limited current literature on acute bilateral foot drop as well as outline possible treatment methods to restore impaired functionality.

"An unusual presentation of a sacral Ewing's sarcoma in a young Syrian female".

A primary spinal Ewing sarcoma is extremely rare to be found. To the best of our knowledge, it is the first reported case for bilateral foot drop as a prodromal symptom of sacral Ewing sarcoma. The case, we are presenting, is of an 18-year-old athletic female, who was presented to the emergency department suffering from sudden severe low back pain radiated to the lower limbs, associated with bilateral foot drop and later urinary incontinence. Following the indicated surgery and subsequent histopathology study, we diagnosed this rare type of tumors. In the following article, we are describing the clinical presenting features of this tumor and discussing the clinical aspects.

Case report of a partially thrombosed ACoA aneurysm presenting with bilateral foot drop.

BACKGROUND AND IMPORTANCE: Foot drop is defined as a weakness in the ankle and foot dorsiflexors. A disruption of the neural pathway starting from the mesial frontal cortex and ending in the peroneal nerve can lead to foot drop. Unilateral foot drop due to lower motor neuron injury is well documented. However, bilateral foot drop due to a central cause is very rare. CLINICAL PRESENTATION: A 29-year-old male presenting with bilateral lower extremity weakness in addition to rigidity. The patient is known to have bipolar disorder and an Anterior communicating artery aneurysm (ACoA) for which he has not followed up. A CTA showed a partially thrombosed 5 mm × 6 mm ACoA aneurysm. The patient underwent placement of flow diverter PED. CONCLUSION: Central causes of acute bilateral foot drop are rare but should be considered in the differential diagnosis. Thrombo-embolism due to a partially thrombosed aneurysm is a well known phenomenon, all treatment options should be considered keeping in mind the risks associated with the different techniques due to the intra saccular thrombus.

Acute Bilateral Isolated Foot Drop: Changing the Paradigm in Management of Degenerative Spine Surgery with Percutaneous Endoscopy.

BACKGROUND: Acute bilateral isolated foot drop due to lumbar disk prolapse with canal stenosis is rare with only 3 cases reported in literature. Our patient was managed using the percutaneous full endoscopic technique. This is mainly to highlight the ease of access and patient outcome with preoperative and postoperative images to support our minimally invasive treatment for this rare condition. CASE DESCRIPTION: A 46-year-old male presented with sudden-onset severe back pain with bilateral foot drop. Clinical examination showed a bilateral L5 radiculopathy with normal perianal sensation. Investigations excluded other causes of bilateral foot drop. A magnetic resonance imaging scan showed disk herniation at the right L4-L5 (inferior migrated) and L5-S1 level (paracentral and extraforaminal) with spinal canal stenosis at the L2-L3 and L5-S1 levels due to ligamentum flavum hypertrophy. The patient underwent percutaneous endoscopic stenosis lumbar decompression at the L2-L3 and L5-S1 level. At the right L4-L5, L5-S1 level, transforaminal endoscopic diskectomy was done using the conventional percutaneous approach. The inferior migrated disk of the L4-L5 level was removed using a left L5-S1 contralateral approach. The patient recovered with favorable outcome and added benefits of minimally invasive surgery. CONCLUSION: Lumbar disk prolapse with canal stenosis should be considered in patients presenting with bilateral isolated foot drop. To our best knowledge, this is the first report of percutaneous endoscopic treatment to address multiple-lumbar-level pathology for this rare condition of acute bilateral isolated foot drop.

Metachronous Bilateral Painless Foot Drop Secondary to Spinal Stenosis: Case Report.

Foot drop (FD) is an uncommon manifestation of nerve root compression secondary to lumbar degenerative disease (LDD). In most of these patients, FD is unilateral and is associated with low back pain and leg pain. A small number of cases have been described with bilateral FD, which is reported to occur simultaneously in a synchronous fashion. A 63-year-old male with a remote history of spinal surgery due to left painless FD presented with a new episode of right FD, this new FD initiated suddenly and it was not associated with low back pain or radicular pain. Magnetic resonance imaging (MRI) showed bilateral lumbar stenosis at L3-4 and subarticular stenosis at right L4-5 level causing compression of right L5 nerve root. Fenestrations, removal of flavum ligament and medial facetectomy were performed bilaterally at L3-4 and on the right side at L4-5 level. Postoperatively, the patient experienced progressive improvement on right foot dorsiflexion. The occurrence of bilateral painless FD presenting in a metachronous way as observed in the present case is a very unusual scenario. To the best of author's knowledge, cases with these characteristics have not been previously reported.

Acute Bilateral Foot Drop as Presenting Symptom of Hemorrhagic Synovial Cyst of Lumbar Spine.

BACKGROUND: Acute bilateral foot drop is a rare clinical presentation. CASE DESCRIPTION: A 77-year-old male presented with acute bilateral weakness of the foot and ankle dorsiflexion. Magnetic resonance imaging of the lumbar spine revealed ligamentum flavum hypertrophy, as well as a mass lesion that appeared hyperintense on T1-weighted images and hypointense on T2-weighted images. Emergent decompressive laminectomy and hemorrhagic synovial cyst excision were performed. Histopathologic examination of the tissue revealed a synovial cyst with hemorrhage. CONCLUSION: Here, we describe a unique case of a hemorrhagic synovial cyst with a presenting symptom of acute bilateral foot drop.

Acute bilateral isolated foot drop: Report of two cases.

Foot drop is defined as the weakness of the foot and ankle dorsiflexion. Acute unilateral foot drop is a well-documented entity, whereas bilateral foot drop is rarely documented. Slowly progressing bilateral foot drop may occur with various metabolic causes, parasagittal intracranial pathologies, and cauda equina syndrome. Acute onset of bilateral foot drop due to disc herniation is extremely rare. Here we present two cases of acute bilateral foot drop due to disc herniation. The first patient was a 45-year-old man presented with acute bilateral foot drop, without any sign of the cauda equina syndrome. Lumbar magnetic resonance imaging of the patient revealed L4-5 disc herniation. To our knowledge, this is the first presented case of acute bilateral foot drop without any signs of cauda equina syndrome caused by L4-5 disc herniation. The second patient was a 50-year-old man who was also presented with acute bilateral foot drop, and had T12-L1 disc herniation with intradural extension. Also this is the first presented case of T12-L1 disc herniation with intradural extension causing acute bilateral foot drop. We performed emergent decompressive laminectomy to both of the patients and extrude disc materials were excised. Both of the patients were recovered with favorable outcome.