Metastatic Brain Cancer, Masquerading as Lumbar Radiculopathy With Foot Drop: A Case Report

BACKGROUND: Foot drop can be caused by pathology at multiple locations within the nervous system. A thorough history and physical examination assists in the identification of a neurological lesion. CASE PRESENTATION: A 70-year-old male was referred from primary care to an outpatient spinal surgical service at a tertiary hospital within the Australian public health service, for low back pain and right leg weakness. The referral was triaged by a consultant spinal surgeon to the physiotherapy-led arm of the spinal surgical service, for initial assessment by an advanced practice physiotherapist. Upon review, the patient’s history and examination were discordant with a condition of spinal origin and raised suspicion for an intracranial lesion. The patient underwent urgent computed tomography (CT) of the brain which demonstrated a brain tumour. OUTCOME AND FOLLOW-UP: A craniotomy and tumour resection was performed by neurosurgery. The patient’s muscle power and function improved post-operatively and the patient was able to discharge home. DISCUSSION: This case demonstrates that a detailed history and physical examination assists in the timely identification of a neurological lesion causing weakness. Physiotherapist-led clinics staffed by advanced practice physiotherapists embedded within outpatient surgical services assist in improving early access to accurate diagnosis and management in collaboration with medical colleagues.