Delayed diagnosis of brain tumor in a patient with flexor spasms and spastic foot drop

Abstract Aims Acute compartment syndrome (ACS) is a surgical emergency. Delayed diagnosis and fasciotomy can result in irreversible muscle necrosis causing permanent disability and major amputation. This study compared patient outcomes following calf fasciotomies to prevent ACS (prophylactic) versus treat ACS (therapeutic) and early (within 6 hours of ACS diagnosis) versus delayed fasciotomies (beyond 6 hours) at a single vascular centre. Methods All patients undergoing calf fasciotomies between 1st January 2017 and 31st December 2020 were identified from a prospectively collected departmental database. Caldecott-approved data collection was conducted. The primary outcomes were wound infection, foot drop, muscle debridement, split-skin graft (SSG) requirement, vacuum dressing, 30-day amputation and death rates. Statistical analysis was performed using Fisher’s exact test. Results 73 patients (51 men, 22 women; median age 67, IQR 56-75 years) underwent calf fasciotomies (44 therapeutic and 29 prophylactic) mainly following acute thromboembolic ischaemia. Higher complication rates occurred among delayed (15) versus early (29) fasciotomy patients: wound infection (13.3% vs 3.4%), foot drop (20.0% vs 3.4%), muscle debridement (40.0% vs 24.1%), loss of anterior compartment (13.3%, 3.4%) need for SSG (29.5% vs 17.2%), vacuum dressing (46.7% vs 20.7%) and 30-day amputation rate (20.0% vs 13.8%) but lower 30-day death rate 13.3% vs 17.2%). None of these results were statistically significant. 34.1% of delayed fasciotomies were due to awaiting emergency theatre availability. Conclusion ACS patients undergoing calf fasciotomies are at high risk of complications including amputation and death. Ongoing education on mortality risk and early communication with emergency theatres are critical in their management.

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Suspicion of anorexia nervosa as a cause of delayed diagnosis of brain tumor. A case report

Pediatric Endocrinology Diabetes and Metabolism ◽

10.18544/pedm-20.03.0012 ◽

2014 ◽

Vol 20 (3) ◽

pp. 123-128

Author(s):

Ewa Niedzielska ◽

◽

Jadwiga Węcławek-Tompol ◽

Bernarda Kazanowska ◽

Ewa Barg ◽

...

Keyword(s):

Anorexia Nervosa ◽

Brain Tumor ◽

Case Report ◽

Delayed Diagnosis

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Reasons for Diagnostic Delay of Foot Drop Caused by Parasagittal Meningioma: Two Case Reports

Case Reports in Neurology ◽

10.1159/000515156 ◽

2021 ◽

pp. 318-323

Author(s):

Duc Thuan Nguyen ◽

Quang An Nguyen ◽

Thi Dung Hoang ◽

Thanh Chung Dang ◽

Trung Duc Le

Keyword(s):

Muscle Power ◽

Case Reports ◽

Diagnostic Delay ◽

Delayed Diagnosis ◽

Complete Recovery ◽

Foot Drop ◽

Delay In Diagnosis ◽

Decompressive Craniotomy ◽

Fibroblastic Meningioma ◽

Parasagittal Meningioma

Foot drop is defined as an impaired ability or inability of dorsiflexion. Peripheral nervous system injuries are commonly considered as the cause of this condition. The central causes including parasagittal meningioma are also described in the literature but very rarely and commonly not recognized early. In this article, we report 2 patients with isolated unilateral foot drop as the first symptom of a parasagittal meningioma and discuss several reasons for delayed diagnosis. Two patients were treated with decompressive craniotomy. The histopathological findings demonstrated a fibroblastic meningioma and a meningothelial meningioma. During postoperative follow-up, the woman patient showed nearly complete recovery and the second case regained total muscle power over a period of 12 months. The rarity of the disease, the absence of upper motor neuron signs, the occurrence of peripheral pathologies and misinterpretation of F wave on nerve conduction study, and motor unit recruitment on electromyography lead to delay in diagnosis and treatment of the central foot drop due to parasagittal meningioma.

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

Journal of Child Neurology ◽

10.1177/0883073813479172 ◽

2013 ◽

Vol 29 (7) ◽

pp. 955-958 ◽

Cited By ~ 2

Author(s):

Edit Goia ◽

Leslie Hamilton ◽

Jennifer Chan ◽

Xing-Chang Wei ◽

Jean K. Mah ◽

...

Keyword(s):

Brain Tumor ◽

Initial Presentation ◽

Foot Drop

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SWK-08. DELAYED DIAGNOSIS OF CENTRAL NERVOUS SYSTEM (CNS) TUMORS IN CHILDREN: PERSPECTIVE FROM THE FRONTLINE

Neuro-Oncology ◽

10.1093/neuonc/noaa222.825 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii466-iii466

Author(s):

Manisha Jogendran ◽

Rebecca Ronsley ◽

Ran D Goldman ◽

Sylvia Cheng

Keyword(s):

Brain Tumor ◽

Delayed Diagnosis ◽

Geographical Location ◽

Family Physicians ◽

Pediatric Brain Tumor ◽

Cns Tumors ◽

Related Factors ◽

Educational Effort ◽

Pediatric Brain ◽

Pediatric Cns Tumors

Abstract Delayed diagnosis of CNS tumors in children is well documented, partially due to challenges in recognizing rare diagnoses. Our objective was to describe Canadian family physicians’ attitudes and confidence in diagnosing and managing pediatric CNS tumors. A standardized questionnaire was administered at a Canadian national family physicians’ conference. Items were based on observations from our institutional study of prediagnostic symptomatic interval in pediatric CNS tumors. 449 surveys were completed. 302/443 (68%) physicians practice in cities. 153/447 (34%) report encountering parents that inquire about their children having brain tumors. 261/449 (58%) have not managed a pediatric brain tumor. 153/447 (34%) report they are not confident, 255/447 (57%) somewhat confident and 39/447 (9%) confident in managing a suspected brain tumor in a stable child. 259/447 (58%) would refer directly to a hospital/specialist. The reported median time for suspicion of a brain tumor was 8–14 days for children with vomiting and/or headache and 1 day for children with seizure and/or ataxia. 410/447 (97%) report not knowing any guidelines to help with management. 235/447 (53%) suggested barriers they experience to include 52/235 (22%) wait times for imaging/specialists, 37/235 (16%) geographical location of the child, 27/235 (12%) knowledge, 25/235 (11%) access to imaging/specialist, and 15/235 (6%) patient-related factors or system barriers, and 8/235 (3%) specialist attitudes. 68/235 (29%) identified no barriers in their practice. This study provides insight into family physicians’ perceived challenges and barriers in diagnosing and managing new suspected pediatric CNS tumors. Educational effort and overcoming systemic perceived barriers may increase physicians’ confidence.

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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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Early-Childhood Education for the Developmentally Delayed: Diagnosis, Intervention, and Evaluation

Language Speech and Hearing Services in Schools ◽

10.1044/0161-1461.1002.81 ◽

1979 ◽

Vol 10 (2) ◽

pp. 81-92

Author(s):

Susan Freedman Gilbert

Keyword(s):

Early Childhood ◽

Early Childhood Education ◽

School Children ◽

Developmental Delays ◽

Delayed Diagnosis ◽

Language Impairments ◽

Developmentally Delayed ◽

Speech And Language ◽

Childhood Education

This paper describes the referral, diagnostic, interventive, and evaluative procedures used in a self-contained, behaviorally oriented, noncategorical program for pre-school children with speech and language impairments and other developmental delays.

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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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