Foot Drop Caused by A Focal Brain Injury: Two Case Report

Kang, Min Su; Youm, Jin Young; Choi, Seung Won; Kim, Sun Hwan; Koh, Hyeon Song; Song, Shi Hun; Kim, Youn

Abstract

Foot drop is caused by peripheral and spinal motor neuron lesions and muscular dystrophy. Foot drop secondary to brain lesions is rarely seen in practice. We present two cases with foot drop caused by focal brain injury. A 49-year-old male patient was admitted with right foot drop for 4m falling down injury. Neurologic examination revealed normal except for weakness at dorsiflexion of the right ankle and big toe. L-spine MRI, L-spine CT and both legs EMG showed normal findings. A 69-year-old male patient was referred with left foot drop and headache after bicycle accident. Neurological examinations showed normal except for weakness in dorsiflexion of the left ankle and big toe without sensory loss. L-spine MRI, L-spine CT and both legs EMG showed normal findings. In first case, there are important focal brain injury lesions in premotor area and SMA. In second case, premotor area, SMA and primary motor area may be damaged. In two cases, hemorrhagic cortical contusions in parasagittal area were the causes of the foot drop. And the foot drop was the initial clinical presentation in both cases. Clinicians, if they detect upper motor type neurologic deficits such as positive Babinski' sign, hyper-reflexia or clonus in a patient with a foot drop, should take into account the possibility of central lesion as reason for the foot drop.