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LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 2  |  Page : 199

Subdural hematoma presenting with unilateral foot drop


1 Department of Neurosurgery, Base Hospital Delhi Cantonment, New Delhi, India
2 Department of Neurosurgery, Command Hospital Northern Command, Udhampur, India
3 Department of Radiology, Command Hospital Northern Command, Udhampur, India

Date of Submission27-Jan-2013
Date of Decision28-Jan-2013
Date of Acceptance09-Mar-2013
Date of Web Publication29-Apr-2013

Correspondence Address:
Sudip Kumar Sengupta
Department of Neurosurgery, Base Hospital Delhi Cantonment, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.111159

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How to cite this article:
Sengupta SK, Bajaj H, Bhattacharya S. Subdural hematoma presenting with unilateral foot drop. Neurol India 2013;61:199

How to cite this URL:
Sengupta SK, Bajaj H, Bhattacharya S. Subdural hematoma presenting with unilateral foot drop. Neurol India [serial online] 2013 [cited 2019 Dec 12];61:199. Available from: http://www.neurologyindia.com/text.asp?2013/61/2/199/111159


Sir,

A 58-year-old lady sustained an accidental fall in the bathroom. There was no history of loss of consciousness, vomiting, headache, seizures or bleeding from nose or ear. Two days after the fall, she developed dull occipitonuchal headache not associated with vomiting and noticed difficulty in lifting the right foot and frequent slipping of the footwear on the right side. Weakness of the right foot increased progressively over next 1 week and stabilized thereafter. There was no history of altered sensorium, backache, or any sensory symptoms in the lower limbs. Clinical examination revealed normal higher mental functions and speech. Pupils were bilaterally equal in size and reacting to light and no papilledema. Motor examinations showed grade 4/5 motor power in right knee extensors and grade 2/5 power in right ankle dorsiflexors and extensor hallucis longus. Motor power in the rest of the muscle groups was normal. Deep tendon jerks were bilaterally normal and plantars bilaterally down going. There was no sensory deficit. Non-contrast computed tomography of the head revealed a left parafalcine subacute subdural hematoma (SDH) [Figure 1]a and b compressing the medial aspect of the frontal lobe. Since there were no feature of raised intracranial pressure and a simple burr hole was considered inadequate to drain this medially located SDH, a trial of conservative management was considered prudent. The lady improved neurologically with complete recovery of motor power over the next 3 weeks.
Figure 1: CT scan head (a) axial section; (b) coronal section showing left parafalcine subacute SDH

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Central causes of foot drop are very rare. The most frequently reported central cause for foot drop is parasagittal meningioma. [1] Traumatic brain injury as the central cause of foot drop has been documented less frequently, with cerebral contusion being the cause for the deficit in all the reported cases. [2] Our patient developed right sided foot drop with progressively increasing motor deficit secondary to a left parafalcine SDH. Though there were no clinical evidence of upper motor neuron involvement, presence of headache, absence of any backache, and sensory deficit pointed to the possibility of a central cause for the foot drop in our patient. Primary motor area includes a group of networked cells in mammalian brains that controls movements of specific body parts associated with cell groups in that area of the brain. There is a precise somatotopic representation of the different body parts in the primary motor cortex, with the leg area located medially. Mass effect of the SDH compressing over the medial aspect of the primary motor cortex is most likely to have caused the weakness in the right leg and foot in our patient.

 
  References Top

1.Narenthiran G, Leach GP, Holland JP. Clinical features of central isolated unilateral foot drop: A case report and review of the literature. Surg Neurol Int 2011;2:27.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.Kang M-S, Youm JY, Choi SW, Kim SH, Koh HS, Song SH, et al. Foot drop caused by a focal brain injury-two case reports. J Korean Neurotraumatol Soc 2005;1:118-21.  Back to cited text no. 2
    


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