Foot drop following lumbar disc herniation/Pie caido luego de Hernia del Nucleo Pulposo Lumbar.
Foot drop is a tibialis anterior muscle weakness, frequently caused by lower motor neuron disease (1). It's usually unilateral and associated with fibular nerve palsy due to fibular head mechanical compression (2).
The authors present a foot drop case associated with lumbar discopathy.
A 38-year-old man showed with a 3-month history of right foot weakness. Neurological examination findings: right inferior extremity claudication during gait, right-sided muscle strength impairment (++/++++) and a L3-dermal territory hypoesthesia on his right leg. Lumbar CT and MRI revealed a L3-L4 central extruded herniated disc (Figure 1). The patient was submitted to lumbar L3-L4 hemilaminectomy and extruded herniated disc excision. Motor physiotherapy and orthesis on the right foot were also performed, with recovery after 3 months of therapy.
Foot drop or tibialis anterior muscle weakness is caused by multiple neurological conditions such as brain lesion (3,4), spinal cord disease (5), multiple sclerosis (6), common fibular nerve mononeuropathy (2) and degenerative lumbar vertebral diseases (7,8,9,10,11). Foot drop related to lumbar disc herniation or spinal canal stenosis has been considered rare (8,9,10,12,13).
Common causes include L5 radiculopathy caused by disc herniation or spinal canal stenosis and fibular nerve neuropahy (3). Other causes include periphereal nervous system axonal demyelination: conus medularis, cauda equina, nervous plexus and peripheral nerves. Foot drop has been reported in 52 - 67% of the patients with upper motor neuron disease, with the following topographies: interhemispheric motor cortex (expansive or arterior cerebral artery lesions), corona radiata, internal capsule and spinal cord (mielopathy).
[FIGURE 1 OMITTED]
Lesions situated in the interhemispheric Assure may be clinically manifested by paracentral lobule uni or bilateral signs, such as lower limb paresis, usually beginning in one extremity and progressively spreading to the opposite limb (3). Ocasionally, there's also association with focal motor or sensory seizures beginning in the foot, urinary or fecal incontinence and mental changes of the frontal lobe syndrom. Parasagital Meningeom is the brain tumor which mostly presents with foot drop. A central lesion can be suspected in patients with upper motor neuron signs such as positive Babinski's sign, hyperreflexia or clonus. These types have been called spastic foot drop (4).
Radiologically the herniated disc is big, central and rarely paramedian located. L4-L5 and L5-S1 localized herniated discs can commonly cause cauda equina compression (14,15,16). In our case the disc herniation was compressing the L3 root. Foot drop may present as acute, subacute or chronic (14,15,16,17,18). Our patient had a chronic evolution due to a poor access to specialized medical care. Foot drop is considered a neurosurgical emergency (14,15,16,17). Our patient was submitted to a lumbar hemilaminectomy and had a slow evolution. Motor physiotherapy and orthesis where both necessary. EMG, CT, mieloCT and MRI should be performed in order to investigate foot drop as a result of lower motor neuron lesion. Early surgical procedure is associated with good prognosis. Due to poor access to specialized medical care, our patient showed slow recovery, however with good case resolution.
Recibido: 06 de junio 2013
Aceptado: 10 de agosto de 2013
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Prof. Dr. Carlos Umberto Pereira
Av. Augusto Maynard, 245/404
Bairro Sao Jose
49015-380 Aracaju- Sergipe
Carlos Umberto Pereira , Guilherme Lepski , Breno Jose Alencar Pires Barbosa 
 Neurosurgeon. Departament Medicine Federal University of Sergipe. Aracaju, Sergipe, Brazil.
 Neurosurgeon. Neurosurgery Division of Hospital das Clinicas. University of Sao Paulo, Brazil.
 Medical Student. Federal University of Pernambuco. Recife, Brazil.
Rev. Chil. Neurocirugia 40:34-36, 2014
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|Title Annotation:||Reporte de Casos|
|Author:||Pereira, Carlos Umberto; Lepski, Guilherme; Barbosa, Breno Jose Alencar Pires|
|Publication:||Revista Chilena de Neurocirugia|
|Date:||Jan 1, 2014|
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