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LETTER TO EDITOR
Year : 2013  |  Volume : 61  |  Issue : 6  |  Page : 679-680

Foot drop caused by cerebral cavernous angioma


Department of Neurosurgery, SVIMS, Tirupati, Andhra Pradesh, India

Date of Submission01-Aug-2013
Date of Decision02-Aug-2013
Date of Acceptance03-Dec-2013
Date of Web Publication20-Jan-2014

Correspondence Address:
V Jayachandar
Department of Neurosurgery, SVIMS, Tirupati, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.125378

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How to cite this article:
Prasad B, Ramesh Chandra V V, Jayachandar V. Foot drop caused by cerebral cavernous angioma. Neurol India 2013;61:679-80

How to cite this URL:
Prasad B, Ramesh Chandra V V, Jayachandar V. Foot drop caused by cerebral cavernous angioma. Neurol India [serial online] 2013 [cited 2019 Dec 12];61:679-80. Available from: http://www.neurologyindia.com/text.asp?2013/61/6/679/125378


Sir,

Foot drop is defined as loss of dorsiflexion of ankle and is commonly due to lesions of the peroneal nerve or fifth lumbar nerve root. [1],[2] Rarely it can be due to cerebral lesions and the most common causes are tumors, [1],[2],[3],[4],[5] trauma [2] and demyelination plaques. [1] Foot drop due to cerebral cavernoma has not been reported.

A 35-year-old woman presented with a history of focal seizures and weakness of the left lower limb of 10 days duration. Neurological examination revealed spasticity of the left lower limb and extensor plantar response and weakness of ankle dorsiflexion (grade 2/5). Brain computed tomography revealed a hyperdense lesion in the right parasagittal parietal region [Figure 1]a and brain magnetic resonance imaging revealed a heterogeneous, altered signal intensity lesion in the right parasagittal parietal region, which was hypointense with hyperintense foci and no contrast enhancement in T1W images [Figure 1]b, e and f.The lesion was hyperintense with hypointense peripheral rim on T2W [Figure 1]c and fluid-attenuated inversion recovery [Figure 1]d sequences. With a diagnosis of right parasagittal cavernoma the patient was taken up for right parasagittal craniotomy and total excision of the cavernoma was done. The diagnosis of cavernoma was confirmed on histopathological examination. The post-operative period was uneventful. At three months follow-up she regained the normal strength of ankle dorsiflexion.
Figure 1: Imaging of the cavernoma

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Lesions of the parietal lobe, in the parasagittal region near the foot homunculus of the motor strip may produce foot drop. [4] Although rare and underappreciated, many cerebral lesions such as glioma, [1] meningioma, [1],[2],[4] abscess, [1] head injury, [1] metastasis, [3],[5] cerebral hemorrhage and demyelination plaques [1] can present with foot drop. Review of the literature revealed twenty four cases of foot drop of cerebral origin. The most common causes identified were glioma followed by meningioma and trauma. However, cerebral cavernoma presenting with foot drop has not been reported, probably our patient may be first such case. Most previous reported cases had accompanying upper motor neuron signs or symptoms such as hyperreflexia, ankle clonus and Babinski signs similar to our patient. [1],[2] Good results [1],[5] were achieved in most of the cerebral causes of foot drop as seen in our patient. Central causes of foot drop should be considered in the differential diagnosis of foot drop when associated with upper motor neuron signs.

 
  References Top

1.Eskandary H, Hamzei A, Yasamy MT. Foot drop following brain lesion. Surg Neurol 1995;43:89-90.  Back to cited text no. 1
[PUBMED]    
2.Baysefer A, Erdoðan E, Sali A, Sirin S, Seber N. Foot drop following brain tumors: Case reports. Minim Invasive Neurosurg1998;41:97-8.  Back to cited text no. 2
    
3.Chatterjee A, Orbach D. Isolated foot weakness caused by a parasagittal metastatic parotid adenocarcinoma. Neurol India 2004;52:286-7.  Back to cited text no. 3
[PUBMED]  Medknow Journal  
4.4 Ozdemir N, Citak G, Acar UD. Spastic foot drop caused by a brain tumour: A case report. Br J Neurosurg 2004;18:314-5.  Back to cited text no. 4
    
5.Westhout FD, Paré LS, Linskey ME. Central causes of foot drop: Rare and underappreciated differential diagnoses. J Spinal Cord Med 2007;30:62-6.  Back to cited text no. 5
    


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