Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Isolated Distal leg Weakness due to a Small Cerebral Infarction Masquerading as a Spinal Lesion

  • Han, In-Bo (Departments of Neurosurgery, Bundang CHA Hospital, Pochon CHA University) ;
  • Ahn, Jung-Yang (Departments of Neurosurgery, Yonsei University, Severance Hospital) ;
  • Chung, Young-Sun (Departments of Neurosurgery, Bundang CHA Hospital, Pochon CHA University) ;
  • Chung, Sang-Sup (Departments of Neurosurgery, Bundang CHA Hospital, Pochon CHA University)
  • Published : 2007.03.30
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Abstract

Acute stroke with isolated monoparesis manifesting as distal weakness of a single lower extremity has rarely been described. We report two patients with small cortical infarction who had distal weakness of a single lower extremity. In both cases, diffusion-weighted image [DWI] was used to detect small lesions in the contralateral cortex. These cases illustrate that small cortical infarction can cause isolated monoparesis limited to distal part of the leg and it may be misdiagnosed as spinal lesions, especially when lower back pain and transient sensory symptoms are accompanied. In case of the abrupt onset of weakness limited to one lower limb, the possibility of stroke should be considered and careful attention to identify cortical lesions using magnetic resonance imaging, especially DWI is required.

Keywords

References

  1. Arboix A, Padilla I, Massons J, Garcia-Eroles L, Comes E, Targa C : Clinical study of 222 patients with pure motor stroke. J Neurol Neurosurg Psychiatry 71 : 239-242, 2001 https://doi.org/10.1136/jnnp.71.2.239
  2. de Freitas GR, Devuyst G, van Melle G, Bonousslavsky J : Motor strokes sparing the leg : different lesions and causes. Arch Neurol 57 : 513-518, 2000 https://doi.org/10.1001/archneur.57.4.513
  3. Gass A, Szabo k, Behrens S, Rossmanith C, Hennerici N : A diffusionweighted MRI study of acute ischemic distal arm paresis. Neurology 57 : 1589-1594, 2001 https://doi.org/10.1212/WNL.57.9.1589
  4. Hochman MS, Deprima SJ, Leon BJ : Diffusion-weighted MRI diagnosis of pure motor stroke limited to primarily distal leg weakness. J Neuroimaging 10 : 118-120, 2000 https://doi.org/10.1111/jon2000102118
  5. Kim JH, Kong MH, Lee SK, Song KY : A case of posterior epidural migration of an extruded lumbar disc fragment causing cauda equina syndrome. J Korean Neurosurg Soc 35 : 442-444, 2004
  6. Kohno Y, Ohkoshi N, Shoji S : Pure motor monoparesis of a lower limb due to a small infarction in the contralateral motor cortex. Clinical Imaging 23 : 149-151, 1999 https://doi.org/10.1016/S0899-7071(99)00126-6
  7. Lee SH, Kim SK, Choi YC, Lee MS, Choi IS : Two cases of cortical infarction presenting as pure motor monoplegia. J Korean Neurol Assoc 12 : 323-328, 1994
  8. Maeder-Ingvar M, van Melle G, Bonousslavsky J : Pure monoparesis : a particular stroke subgroup? Arch Neurol 62 : 1221-1224, 2005 https://doi.org/10.1001/archneur.62.8.1221
  9. Paciaroni M, Caso V, Milia P, Venti M, Silvestrelli G, Palmerini F, et al : Isolated monoparesis following stroke. J Neurol Neurosurg Psychiatry 76 : 805-807, 2004 https://doi.org/10.1136/jnnp.2004.047779
  10. Phan TG, Evans BA, Huston J : Pseudoulnar palsy from a small infarct of the precentral knob. Neurology 54 : 2185, 2000 https://doi.org/10.1212/WNL.54.11.2185
  11. Tei H : Monoparesis of the right hand following a localized infarct in the left 'precentral knob'. Neuroradiology 41 : 269-270, 1999 https://doi.org/10.1007/s002340050745
  12. Yoneda Y, Mori E, Tabuchi M, Yamadori A : Pure motor monoparesis due to intracerebral hemorrhage. Stroke 24 : 142-143, 1993 https://doi.org/10.1161/01.STR.24.1.142