Chiari 1 malformation and holocord syringomyelia presenting as abrupt onset foot drop

We present two patients with a Chiari 1 malformation and holocord syringomyelia who presented with abrupt onset unilateral foot drop. Neurophysiologic testing was consistent with a proximal nerve root lesion. This assisted with localization and directed magnetic resonance (MR) imaging to lumbosacral spine and nerve roots. Each child underwent a suboccipital craniectomy and laminectomy with duroplasty to decompress the foramen magnum. Each child also showed rapid and complete clinical recovery despite the significant electromyographic and MRI abnormalities on initial study.     

A case of mistaken identity: a fourth ventricular tumor presenting as school phobia in a 12 year old boy

A 12 year old boy was diagnosed as having overanxious disorder of childhood and school phobia. He was later found to be suffering from the effects of a cerebral tumor. Surgical removal of the tumor led to alleviation of the anxiety. The authors utilize this case to illustrate some aspects of differential diagnosis in child psychiatry. In particular, they point out the necessity of comprehensive physical examination in child psychiatry impatient units. The danger of attributing physical symptoms to functional illness purely in the absence of positive physical findings is noted. The importance of utilizing a biopsychosocial diagnostic model in child psychiatry is stressed.     

Cerebral contusion as a rare cause of foot drop: case report

A 74-year-old woman, taking anticoagulant therapy for chronic heart failure, presented to our emergency room with left dorsiflexion weakness 8 hours from after multitrauma. A detailed neurological examination revealed only 0/5 strength in the left foot dorsiflexion without any upper motor neuron signs. While there was no spinal cord pathology detected, cranial computed tomography demonstrated a lesion in the right parasagittal localization consistent with hemorrhagic contusion. Clinical follow-ups showed an improvement in neurological findings with muscle power of 3/5 in day 5 and 5/5 in day 45 of admission. The parasagittal region has a foot localization in the homonculus and lesions in this area can rarely present with the foot drop sign. Thus, parasagittal region lesions should always be kept in mind in foot drop cases.     

Two differential cavities in syringomyelia of pediatric Chiari I malformation presenting with unilateral foot drop

IntroductionPatients with Chiari I malformation (CM1) may have chronic symptoms of syringomyelia, including numbness and weakness of the upper limbs, typically during young adulthood. Acute or subacute presentation of unilateral foot drop has been rarely reported as a first symptom of CM1-associated syringomyelia exclusively in childhood or adolescence. Why these patients do not show any symptoms of the upper limbs although holocord syringomyelia is always observed on magnetic resonance imaging (MRI) is unclear.Case presentationA four-year-old girl presented rapidly with isolated left foot drop. Conventional MRI revealed holocord syringomyelia associated with CM1. Three-dimensional constructive interference in steady state (3D-CISS) imaging further demonstrated that the syringomyelia was comprised of two differential cavities that communicated with each other via a small pore: a centrally positioned upper cavity and a left-deviated lower one. Surgical decompression of the foramen magnum resolved the symptom with radiological improvement of the two cavities.ConclusionIn contrast to a centrally enlarged syrinx that is often asymptomatic, a paracentrally extended syrinx usually produces segmental signs related to its levels. Thus, the left foot drop in this case would have been due to the ipsilaterally deviated lower cavity that was distinguished from the central upper cavity by 3D-CISS imaging. Further reports using this imaging technique are needed to verify the hypothetic pathology.     

Statin-induced bilateral foot drop in a case of hypothyroidism

Muscle involvement is a common manifestation of both clinical and subclinical hypothyroidism, with serum creatine kinase (CK) elevation being probably the most common manifestation, and is seen in up to 90% of patients, but is usually mild (less than 10 times the upper limit of normal). Rhabdomyolysis is a distinctively uncommon presentation of hypothyroidism described usually in the setting of precipitating events such as strenuous exercise, alcohol, or statin use. Rarely rhabdomyolysis and myoedema seen in hypothyroidism can be complicated by the development of anterior compartment syndrome leading to neurovascular compression. We describe a case of a patient with hypothyroidism who developed acute onset bilateral foot drop on initiation of statins. This case highlights the need for cautious use of statins in patients at risk for rhabdomyolysis.     

Severe obsessive-compulsive syndrome in a 10 year old: a 3 year follow-up

Obsessive-Compulsive Disorder is rare in children but when present, its very nature is so pervasive and so complex that the therapy must be specially tailored to fit the distinct character of the young patient. We report the course and treatment of one case; then we discuss the interplay of implicit as well as explicit factors in the active process of alleviating dysfunctional behavior.     

Ganser syndrome in a 10 year old boy--an 8 year follow up

A case of pseudodementia in a 10 year old boy was first reported in 1981. When reviewed 8 years after initial presentation, his symptoms were largely unchanged. The case continues to be complicated by claims for compensation and a successful appeal against the initial compensation judgment.     

Vertebral canal abscess as a complication of congenital sacral sinus in a two year old girl

Vertebral canal abscess is rather an uncommon disease. Since 1830, when the first report that spinal of abscess was published. Till to 2000, no more than 20 cases as a result of dermal sinus infection were reported. Dermal sinus results from an incomplete separation of the cutaneus ectoderm from the neural ectoderm between the 4 and 6 weeks of fetal development. Surgical excision of the sinus is the treatment of choice for prevention of infection. The authors describes a 2-year-old girl with that abscess secondary to dorsal dermal sinus in sacral region. The patient presented with fever, since two weeks, flaccid paraparesis mainly in the right lower extremity, urinary and bowel incontinence. The child was initially treated conservatively, and after limitation of inflammatory process the dermal sinus and dermoid cyst containing a large quantity of pus were excised. The authors reviewed the literature of spinal cord abscesses secondary to congenital dermal sinus. The diagnostic and therapeutic methods presented in the literature are discussed in comparison with our case.     

Bilateral drop foot secondary to a primary tumor in the conus medullaris

Intramedullary tumors of the spinal cord are rare neoplasms that can be associated with severe neurological and functional handicaps. To our knowledge, we describe for the first time the case of a male patient who developed bilateral drop foot as an initial manifestation of a primary tumor in the conus medullaris of the spinal cord, probably an astrocytoma.     

Temporal lobectomy for epilepsy in a three year old: a twenty year followup.

Few series have analyzed the results of temporal lobectomy in the pediatric age group. In this paper, we present a child who underwent successful temporal lobectomy for medically intractable complex partial seizures at the age of three. A twenty year followup is provided. This case is significant because of the young age at which the surgery was performed, the long term followup which was obtained, and the successful result. Followup included multiple clinic visits, electroencephalograms (EEG), and psychological testing. The patient is currently seizure free and functioning well in society.