Unilateral Foot Drop as an Initial Presentation of a Brain Tumor in a Child

Background. Polyarteritis nodosa (PAN) is a form of necrotizing vasculitis affecting medium or small blood vessels with multiorgan involvement. Although myalgia is a clinical feature of PAN, severe disabling myalgia as the initial presentation is rarely noted. Case Presentation. We present a case of 54-year-old male with recently detected chronic kidney disease admitted with progressive severe disabling muscular pains predominantly over calves with constitutional symptoms for seven weeks. He was weak to mobilize out of the bed. Later, he developed a vasculitic rash, unilateral ulnar claw, and bilateral foot drop. His skin and muscle biopsies showed evidence of vasculitis. His renal and mesenteric artery CT angiogram revealed stenosed segment of the celiac artery without evidence of visible aneurysms elsewhere. He completed six cycles of intravenous cyclophosphamide pulse therapy with high-dose oral prednisolone with good response. With continuation of aggressive immunosuppression and rehabilitation for five months, the patient improved and was able to walk without support. Conclusion. Musculoskeletal predominant PAN, even though rare, needs to be considered in patients presenting with disabling muscle pain and weakness. These features may herald over days to months along with constitutional symptoms before other systems getting affected. Early recognition of such symptoms and initiating specific treatment would be important for better outcomes.

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Poster 76 Unusual Presentation of Brain Tumor: Foot Drop: A Case Report

PM&R ◽

10.1016/j.pmrj.2012.09.702 ◽

2012 ◽

Vol 4 ◽

pp. S215-S215

Author(s):

Sonia Shetty ◽

Dennis J. Keane

Keyword(s):

Brain Tumor ◽

Case Report ◽

Unusual Presentation ◽

Foot Drop

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Rating Post-Operative Backs (Part I)

Guides Newsletter ◽

10.1001/amaguidesnewsletters.1997.julaug01 ◽

1997 ◽

Vol 2 (4) ◽

pp. 1-3

Author(s):

James B. Talmage

Keyword(s):

Spinal Stenosis ◽

Foot Drop ◽

Neurogenic Claudication ◽

Root Damage ◽

Fourth Edition ◽

Minor Strain ◽

Injury Model ◽

Strain Type ◽

A Minor ◽

Anterior Tibialis

Abstract The AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, uses the Injury Model to rate impairment in people who have experienced back injuries. Injured individuals who have not required surgery can be rated using differentiators. Challenges arise when assessing patients whose injuries have been treated surgically before the patient is rated for impairment. This article discusses five of the most common situations: 1) What is the impairment rating for an individual who has had an injury resulting in sciatica and who has been treated surgically, either with chemonucleolysis or with discectomy? 2) What is the impairment rating for an individual who has a back strain and is operated on without reasonable indications? 3) What is the impairment rating of an individual with sciatica and a foot drop (major anterior tibialis weakness) from L5 root damage? 4) What is the rating for an individual who is injured, has true radiculopathy, undergoes a discectomy, and is rated as Category III but later has another injury and, ultimately, a second disc operation? 5) What is the impairment rating for an older individual who was asymptomatic until a minor strain-type injury but subsequently has neurogenic claudication with severe surgical spinal stenosis on MRI/myelography? [Continued in the September/October 1997 The Guides Newsletter]

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