Aggressive lumbar vertebral hemangioma presenting with foot drop mimicking spinal tuberculosis: A case report

Background: Aggressive vertebral hemangiomas are uncommon vascular lesions that may present with epidural extension and neurological deficit. In tuberculosis-endemic regions, atypical vertebral hemangiomas may mimic spinal tuberculosis, resulting in diagnostic confusion and delay in definitive management. Case Description: A 20-year-old male presented with a 1-year history of left lower-limb radiculopathy followed by progressive left foot drop for 1 month. The patient had previously received empirical antitubercular therapy without clinical improvement. Magnetic resonance imaging demonstrated an expansile lesion involving the L1 vertebral body and posterior elements with epidural extension causing severe canal stenosis and compression at the conus medullaris and cauda equina junction. Preserved intervertebral discs and characteristic imaging findings suggested an aggressive vertebral hemangioma. The patient underwent posterior stabilization with D12 and L2 pedicle screw fixation along with L1 laminectomy and decompression. Intralesional chemical cauterization using absolute alcohol was performed intraoperatively. Histopathological examination confirmed vertebral hemangioma. Significant postoperative neurological improvement was observed with recovery of foot dorsiflexion. Conclusion: Aggressive lumbar vertebral hemangiomas may rarely present with foot drop and mimic spinal tuberculosis. Careful radiological evaluation and individualized surgical management with timely decompression and stabilization are essential for favorable neurological outcomes.