Abstract
Differential diagnoses of ankle dorsiflexion weakness or foot drop are numerous and may include common fibular mononeuropathy, L5 and/or L4 nerve root lesion, partial sciatic neuropathy, acquired or hereditary peripheral polyneuropathy, central nervous system pathology, cervical or thoracic myelopathy and motor neuron disease. This case details the subjective and objective clinical exam, electrophysiological testing and interventions for a 54-year-old female with a referring diagnosis of a right foot drop deformity. The clinical exam identified distal, bilateral lower extremity (BLE) weakness and necessitated further evaluation of bilateral upper extremities (BUE) and cranial nerves. Electrophysiological testing, including nerve conduction studies (NCS) and needle electromyography (EMG), demonstrated findings consistent with motor neuron disease (MND) in all muscles tested in BUE, BLE, bilateral low lumbar paravertebral muscles and right tongue. A neurologist confirmed the presence of MND and determined this disease process was most likely amyotrophic lateral sclerosis. The patient was referred to the Neuromuscular Disease Clinic at a university hospital for further evaluation. Two months following the electrophysiological testing, the patient reported worsening weakness in BLE that had caused her to fall several times. She denied progression of BUE weakness or development of bulbar symptoms but relied on family members for assistance with some activities of daily living.
Published Version
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