Öz
Objective: In this study, we aimed to reveal the etiologic and electrophysiologic characteristics of patients with foot drop referred to the neurophysiology laboratory.
Materials and Methods: The clinical and electrophysiologic findings of 127 patients referred to the electromyography (EMG) laboratory between January 2019 and September 2022 were retrospectively evaluated.
Results: The ages of the 114 patients included in the study ranged between 18-85 years (mean 49.6). 31% of the patients were female and 69% were male. 79 cases were referred from internal medicine and 35 cases were referred from surgery. The most common etiology of foot drop was fibular nerve injury (44.7%), followed by radiculopathy 21.9%, sciatic nerve injury 16.7%, polyneuropathy 10.5%, lumbosacral plexopathy 4.4%, anterior horn motor neuron disease 1.8%. Unilateral and bilateral foot drop was present in 83% and 17% of the cases, respectively. Of the 19 patients with bilateral foot drop, 12 had polyneuropathy, 3 had radiculopathy (L4-5, S1 root), 2 had fibular head neuropathy, 1 had lumbosacral plexopathy, and 1 had anterior horn motor neuron disease. Electrophysiologic findings were axonal in 85% of cases and demyelinating in 11%, while demyelinating or axonal damage could not be differentiated in 4% of cases. Fibular nerve injury was the most common etiologic factor in cases referred from internal and surgical branches, but polyneuropathy was more common in internal branches (13% of cases) than in surgical branches (5% of cases). In all cases, the clinically affected area and the area of pathologic electrophysiologic findings were consistent with each other.
Conclusion: Although fibular nerve neuropathy is common in the etiology of patients referred with foot drop, different etiologies may be detected. Electrophysiologic tests are guiding in the determination of peripheral pathology in these cases. Therefore, electrophysiological findings obtained together with neurological examination should be taken into consideration in determining the lesion localisation and planning the investigations to be performed for the etiology in patients with foot drop.
Anahtar Kelimeler
Kaynakça
- 1. Wang Y, Nataraj A. Foot drop resulting from degenerative lumbar spinal diseases: clinical characteristics and prognosis. Clin Neurol Neurosurg. 2014;117:33-39.
- 2. Cruz-Martinez A, Arpa J, Palau F. Peroneal neuropathy after weight loss. J Peripher Nerv Syst. 2000;5(2):101-5.
- 3. Bowley MP, Doughty CT. Entrapment Neuropathies of the Lower Extremity. Med Clin North Am. 2019;103(2):371-82
- 4. Marciniak C. Fibular (peroneal) neuropathy: electrodiagnostic features and clinical correlates. Phys Med Rehabil Clin N Am. 2013;24(1):121-37.
- 5- Guigui P, Delecourt C, Delhoume J, Lassale B, Deburge A. Severe motor weakness associated with lumbar spinal stenosis. A retrospective study of a series of 61 patients. Rev Chir Orthop Reparatrice Appar Mot. 1997;83(7):622-8.
- 6. Andersson H, Carlsson CA. Prognosis of operatively treated lumbar disc herniations causing foot extensor paralysis. Acta Chir Scand. 1966;132(5):501-6.
- 7. Katirji MB, Wilbourn AJ. Common peroneal mononeuropathy: a clinical and electrophysiologic study of 116 lesions. Neurology. 1988;38(11):1723-8.
- 8. Aono H, Iwasaki M, Ohwada T, Okuda S, Hosono N, Fuji T, Yoshikawa H. Surgical outcome of drop foot caused by degenerative lumbar diseases. Spine (Phila Pa 1976). 2007;32(8):E262-6.
- 9. Iizuka Y, Iizuka H, Tsutsumi S, Nakagawa Y, Nakajima T, Sorimachi Y, Ara T, Nishinome M, Seki T, Shida K, Takagishi K. Foot drop due to lumbar degenerative conditions: mechanism and prognostic factors in herniated nucleus pulposus and lumbar spinal stenosis. J Neurosurg Spine. 2009;10(3):260-4
- 10. Guigui P, Benoist M, Delecourt C, Delhoume J, Deburge A. Motor deficit in lumbar spinal stenosis: a retrospective study of a series of 50 patients. J Spinal Disord. 1998;11(4):283-8.
- 11. Feinberg J, Sethi S. Sciatic neuropathy: case report and discussion of the literature on postoperative sciatic neuropathy and sciatic nerve tumors. HSS J. 2006;2(2):181-7
- 12. Shapiro BE, Preston DC. Entrapment and compressive neuropathies. Med Clin North Am. 2009;93(2):285 315.
- 13. Geyik S, Geyik M, Yigiter R, Kuzudisli S, Saglam S, Elci MA, Yilmaz M. Preventing Sciatic Nerve Injury due to Intramuscular Injection: Ten-Year Single-Center Experience and Literature Review. Turk Neurosurg. 2017;27(4):636-40.
- 14. Cherian RP, Li Y. Clinical and Electrodiagnostic Features Of Nontraumatic Sciatic Neuropathy. Muscle Nerve. 2019;59(3):309-14.
- 15. Yuen EC, Olney RK, So YT. Sciatic neuropathy: clinical and prognostic features in 73 patients. Neurology. 1994;44(9):1669-74.
- 16. Distad BJ, Weiss MD. Clinical and electrodiagnostic features of sciatic neuropathies. Phys Med Rehabil Clin N Am. 2013;24(1):107-20.
- 17. Yuen EC, So YT, Olney RK. The electrophysiologic features of sciatic neuropathy in 100 patients. Muscle Nerve. 1995;18(4):414-20.
- 18. Kadioglu HH. Sciatic Nerve Injuries from Gluteal Intramuscular Injection According to Records of the High Health Council. Turk Neurosurg. 2018;28(3):474-78.
- 19. Dydyk AM, Hameed S. Lumbosacral Plexopathy. [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556030/
- 20. Jaeckle KA, Young DF, Foley KM. The natural history of lumbosacral plexopathy in cancer. Neurology. 1985;35(1):8-15.
- 21. Gonzalez Calzada N, Prats Soro E, Mateu Gomez L, Giro Bulta E, Cordoba Izquierdo A, Povedano Panades M, Dorca Sargatal J, Farrero Muñoz E. Factors predicting survival in amyotrophic lateral sclerosis patients on non-invasive ventilation. Amyotroph Lateral Scler Frontotemporal Degener. 2016;17(5-6):337-42.
- 22. Chen L, Zhang B, Chen R, Tang L, Liu R, Yang Y, Yang Y, Liu X, Ye S, Zhan S, Fan D. Natural history and clinical features of sporadic amyotrophic lateral sclerosis in China. J Neurol Neurosurg Psychiatry. 2015;86(10):1075-81.
- 23. Hu, F., Jin, J., Chen, Q. et al. Dissociated lower limb muscle involvement in amyotrophic lateral sclerosis and its differential diagnosis value. Sci. Rep.; 2019; 9: 17786.
- 24. Stewart JD. Foot drop: where, why and what to do? Pract Neurol. 2008;8(3):158-69.
- 25. Azhary H, Farooq MU, Bhanushali M, Majid A, Kassab MY. Peripheral neuropathy: differential diagnosis and management. Am Fam Physician. 2010;81(7):887-92.
- 26- Ku BD, Lee EJ, Kim H. Cerebral infarction producing sudden isolated foot drop. J Clin Neurol. 2007;3(1):67-9
- 27. lhardallo M, El Ansari W, Baco AM. Second ever reported case of central cause of unilateral foot drop due to cervical disc herniation: Case report and review of literature. Int J Surg Case Rep. 2021;83:105928.
- 28. Kim KW, Park JS, Koh EJ, Lee JM. Cerebral infarction presenting with unilateral isolated foot drop. J Korean Neurosurg Soc. 2014;56(3):254-6.
Nörofizyoloji Laboratuvarına Düşük Ayak Tanısıyla Yönlendirilen Olguların Retrospektif Değerlendirilmesi
Öz
Amaç: Bu çalışmamızda düşük ayak ön tanısı düşünülerek nörofizyoloji laboratuvarına yönlendirilen olguların etiyolojik ve elektrofizyolojik özelliklerini ortaya koymayı amaçladık.
Gereç ve Yöntem: Ocak 2019 - Eylül 2022 arasında düşük ayak kliniği nedeniyle elektromiyografi (EMG) laboratuvarına yönlendirilen 127 olgunun klinik ve elektrofizyolojik bulguları retrospektif olarak değerlendirildi.
Bulgular: Çalışmaya dahil edilen 114 olgunun yaşları 18-85 (ort. 49,6) aralığında değişmekteydi. Olguların %31 i kadın, %69 u erkekti. 79 olgu dahili, 35 olgu ise cerrahi branşlardan yönlendirilmişti. Düşük ayak etiyolojisi olarak en sık fibuler sinir hasarı (%44.7) saptanmakla birlikte, sıklık sırasına göre radikülopati %21.9, siyatik sinir hasarı %16.7, polinöropati %10.5, lumbosakral pleksopati %4.4, ön boynuz motor nöron hastalığı %1,8 oranında saptanan diğer etiyolojilerdi. Olguların %83 ünde tek taraflı, %17 sinde bilateral düşük ayak mevcuttu. Bilateral düşük ayak saptanan 19 olgunun 12 sinde polinöropati, 3’ünde radikülopati (L4-5, S1 kök), 2’sinde fibula başı nöropatisi, 1’inde lumbosakral pleksopati, 1’inde ön boynuz motor nöron hastalığı mevcuttu. Elektrofizyolojik bulgular, olguların %85’inde aksonal, %11’inde demiyelinizan özellik göstermekteyken, %4 olguda demyelinizan veya aksonal hasar ayırdedilemedi. Fibular sinir hasarı dahili ve cerrahi branşlardan yönlendirilen olgularda en sık etiyolojik etken olmakla birlikte, dahili branşlarda polinöropati cerrahi branşlara göre daha sık saptandı. Tüm olgularda klinik olarak etkilenen bölge ile patolojik elektrofizyolojik bulguların elde edildiği bölge birbiri ile uyumluydu.
Sonuç: Düşük ayak kliniği ile yönlendirilen hastalarda etiyolojide fibular sinir nöropatisi sık olsa da, farklı etiyolojiler saptanabilir Elektrofizyolojik testler bu olgularda periferik patolojinin belirlenmesinde yol göstericidir. Bu nedenle düşük ayak kliniği olan olgularda lezyon lokalizasyonunun belirlenmesinde, etiyolojiye yönelik yapılması gereken tetkiklerin planlanmasında, nörolojik muayene ile birlikte elde edilen elektrofizyolojik bulgular mutlaka göz önünde bulundurulmalıdır.
Not: Bu çalışma 38.Ulusal Klinik Nörofizyoloji EEG-EMG Kongresi’nde (26-30 Ekim 2022) sözel bildiri şeklinde sunulmuştur.
Anahtar Kelimeler
Kaynakça
- 1. Wang Y, Nataraj A. Foot drop resulting from degenerative lumbar spinal diseases: clinical characteristics and prognosis. Clin Neurol Neurosurg. 2014;117:33-39.
- 2. Cruz-Martinez A, Arpa J, Palau F. Peroneal neuropathy after weight loss. J Peripher Nerv Syst. 2000;5(2):101-5.
- 3. Bowley MP, Doughty CT. Entrapment Neuropathies of the Lower Extremity. Med Clin North Am. 2019;103(2):371-82
- 4. Marciniak C. Fibular (peroneal) neuropathy: electrodiagnostic features and clinical correlates. Phys Med Rehabil Clin N Am. 2013;24(1):121-37.
- 5- Guigui P, Delecourt C, Delhoume J, Lassale B, Deburge A. Severe motor weakness associated with lumbar spinal stenosis. A retrospective study of a series of 61 patients. Rev Chir Orthop Reparatrice Appar Mot. 1997;83(7):622-8.
- 6. Andersson H, Carlsson CA. Prognosis of operatively treated lumbar disc herniations causing foot extensor paralysis. Acta Chir Scand. 1966;132(5):501-6.
- 7. Katirji MB, Wilbourn AJ. Common peroneal mononeuropathy: a clinical and electrophysiologic study of 116 lesions. Neurology. 1988;38(11):1723-8.
- 8. Aono H, Iwasaki M, Ohwada T, Okuda S, Hosono N, Fuji T, Yoshikawa H. Surgical outcome of drop foot caused by degenerative lumbar diseases. Spine (Phila Pa 1976). 2007;32(8):E262-6.
- 9. Iizuka Y, Iizuka H, Tsutsumi S, Nakagawa Y, Nakajima T, Sorimachi Y, Ara T, Nishinome M, Seki T, Shida K, Takagishi K. Foot drop due to lumbar degenerative conditions: mechanism and prognostic factors in herniated nucleus pulposus and lumbar spinal stenosis. J Neurosurg Spine. 2009;10(3):260-4
- 10. Guigui P, Benoist M, Delecourt C, Delhoume J, Deburge A. Motor deficit in lumbar spinal stenosis: a retrospective study of a series of 50 patients. J Spinal Disord. 1998;11(4):283-8.
- 11. Feinberg J, Sethi S. Sciatic neuropathy: case report and discussion of the literature on postoperative sciatic neuropathy and sciatic nerve tumors. HSS J. 2006;2(2):181-7
- 12. Shapiro BE, Preston DC. Entrapment and compressive neuropathies. Med Clin North Am. 2009;93(2):285 315.
- 13. Geyik S, Geyik M, Yigiter R, Kuzudisli S, Saglam S, Elci MA, Yilmaz M. Preventing Sciatic Nerve Injury due to Intramuscular Injection: Ten-Year Single-Center Experience and Literature Review. Turk Neurosurg. 2017;27(4):636-40.
- 14. Cherian RP, Li Y. Clinical and Electrodiagnostic Features Of Nontraumatic Sciatic Neuropathy. Muscle Nerve. 2019;59(3):309-14.
- 15. Yuen EC, Olney RK, So YT. Sciatic neuropathy: clinical and prognostic features in 73 patients. Neurology. 1994;44(9):1669-74.
- 16. Distad BJ, Weiss MD. Clinical and electrodiagnostic features of sciatic neuropathies. Phys Med Rehabil Clin N Am. 2013;24(1):107-20.
- 17. Yuen EC, So YT, Olney RK. The electrophysiologic features of sciatic neuropathy in 100 patients. Muscle Nerve. 1995;18(4):414-20.
- 18. Kadioglu HH. Sciatic Nerve Injuries from Gluteal Intramuscular Injection According to Records of the High Health Council. Turk Neurosurg. 2018;28(3):474-78.
- 19. Dydyk AM, Hameed S. Lumbosacral Plexopathy. [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556030/
- 20. Jaeckle KA, Young DF, Foley KM. The natural history of lumbosacral plexopathy in cancer. Neurology. 1985;35(1):8-15.
- 21. Gonzalez Calzada N, Prats Soro E, Mateu Gomez L, Giro Bulta E, Cordoba Izquierdo A, Povedano Panades M, Dorca Sargatal J, Farrero Muñoz E. Factors predicting survival in amyotrophic lateral sclerosis patients on non-invasive ventilation. Amyotroph Lateral Scler Frontotemporal Degener. 2016;17(5-6):337-42.
- 22. Chen L, Zhang B, Chen R, Tang L, Liu R, Yang Y, Yang Y, Liu X, Ye S, Zhan S, Fan D. Natural history and clinical features of sporadic amyotrophic lateral sclerosis in China. J Neurol Neurosurg Psychiatry. 2015;86(10):1075-81.
- 23. Hu, F., Jin, J., Chen, Q. et al. Dissociated lower limb muscle involvement in amyotrophic lateral sclerosis and its differential diagnosis value. Sci. Rep.; 2019; 9: 17786.
- 24. Stewart JD. Foot drop: where, why and what to do? Pract Neurol. 2008;8(3):158-69.
- 25. Azhary H, Farooq MU, Bhanushali M, Majid A, Kassab MY. Peripheral neuropathy: differential diagnosis and management. Am Fam Physician. 2010;81(7):887-92.
- 26- Ku BD, Lee EJ, Kim H. Cerebral infarction producing sudden isolated foot drop. J Clin Neurol. 2007;3(1):67-9
- 27. lhardallo M, El Ansari W, Baco AM. Second ever reported case of central cause of unilateral foot drop due to cervical disc herniation: Case report and review of literature. Int J Surg Case Rep. 2021;83:105928.
- 28. Kim KW, Park JS, Koh EJ, Lee JM. Cerebral infarction presenting with unilateral isolated foot drop. J Korean Neurosurg Soc. 2014;56(3):254-6.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Nöroloji ve Nöromüsküler Hastalıklar |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Eylül 2024 |
| Gönderilme Tarihi | 11 Aralık 2023 |
| Kabul Tarihi | 10 Ocak 2024 |
| Yayımlandığı Sayı | Yıl 2024 |