Lumbosacral Radiculoplexopathy Research Articles

Role of magnetic resonance neurography in assessment of lumbosacral radiculo-plexopathy: correlation with electrophysiological studies

BackgroundLumbosacral plexus is a collection of nerves that converge and diverge and finally merge into terminal nerves that innervate the pelvis and lower limbs. Lumbosacral plexopathy is a clinical disease characterized by motor and sensory abnormalities that can result from damage to the lumbosacral plexus by different types of insults. Electrophysiological studies are used to demonstrate the presence of lumbosacral radiculo-plexopathy, but it is restricted owing to deep position of nerves and regional differences in muscle nerve supply. High-resolution MR neurography can simply show the precise site, size, etiology, and type of the lumbosacral radiculo-plexopathy. The aim of this study was to assess the various diseases affecting the lumbosacral plexus with their 1.5-T MR neurography imaging findings and to correlate these findings with electrophysiological studies.ResultsFifty adult patients with clinical presentation of lumbosacral radiculo-plexopathy were included in this cross-sectional study. Based on clinical diagnosis, the sensitivity of electrophysiological studies in diagnosing lumbosacral radiculo-plexopathy was 80% and the sensitivity of MR neurography in diagnosing lumbosacral radiculo-plexopathy was 90%. While based on electrophysiological studies, the sensitivity of MR neurography in diagnosing lumbosacral radiculo-plexopathy was 97.5% and the specificity was 75.86%. There was a high statistically significant relation between the side affected in electrophysiological studies and the side affected in MR neurography and between the stage of the lesion in the electrophysiological studies and in MR neurography among patients (p ≤ 0.001, p ≤ 0.001) , respectively.ConclusionsMR neurography of the lumbosacral plexus is a helpful non-invasive approach for the assessment of patients with inconclusive lumbar spine MR imaging because of its ability for diagnosis of neuromuscular lesions and determining their causes. Electrophysiological studies assess the nerve function and MR neurography assesses the nerve anatomy, and therefore, the correlation between electrophysiological studies and MR neurography are complementary for detection of lumbosacral radiculo-plexopathy.

Paraparesis due to ischemic lumbosacral Radiculoplexopathy

Background: Lumbosacral radiculoplexopathy (LSRP) is a rare entity, with several etiologies described in the literature. Vascular lesions to the lower part of the aorta and the common iliac artery can cause LSRP of ischemic etiology. Clinical Presentation: A 66-year-old man with a previous history of peripheral obstructive arterial disease (POAD) requiring aortobifemoral and femoropopliteal procedures had a prolonged hospital stay due to various complications: stent infection and occlusion, aortoenteric fistula causing hemorrhagic shock, transmetatarsal amputation of the right foot. In this context, he underwent multiple endovascular procedures. At discharge, the patient presented flaccid paraparesis, distal bilateral hypoesthesia, saddle anesthesia and urinary and anal incontinence. Spinal cord infarction was excluded. An electromyographic study confirmed the diagnosis of bilateral LSRP of ischemic etiology. Conclusion: This case highlights the importance of including ischemic etiology as a differential diagnosis of peripheral nerve injuries, namely in patients with POAD.

Etiology of Lumbosacral Radiculoplexopathy: Sacral Insufficiency Fracture on Magnetic Resonance Imaging.

Sacral insufficiency fracture (SIF) can cause lumbosacral radiculoplexopathy (LSRP) and is probably under-recognized. Symptoms may include nonspecific lumbar spine or buttock pain that is exacerbated by physical activity and alleviated with rest. The frequency of LSRP secondary to SIF has not been reported. We aimed to determine the frequency of LSRP associated with SIF using magnetic resonance imaging (MRI) of the lumbar spine. We searched a radiology database at our institution using the keywords "sacral insufficiency fracture" and "lumbar spine MRI" for patient records from January 2014 through December 2017. We assessed for the presence of LSRP, reflected by elevated T2-weighted or short tau inversion recovery (STIR) signal intensity and enlargement of the nerve on noncontrast lumbar spine MRI. An incompletely healed vertically oriented SIF was confirmed if there was a persistent bone marrow edema pattern adjacent to the fracture site; we did not include purely transverse SIFs. The final cohort comprised 57 patients (48 female; age range, 14 to 89years). Abnormalities of the extraforaminal L5 nerve root or the combined L4 and L5 nerve roots (the lumbosacral trunk) were identified in 19 (33%) of 57 patients, with a total of 23 sites (bilateral involvement in four cases). Of the 23 abnormal nerves, 19 (82.6%) had corresponding, clinically documented radicular symptoms and 16 (69.6%) had no other explanation on MRI for their radicular symptoms other than SIF. LSRP caused by SIF is an entity all radiologists should be cognizant of, especially in cases of otherwise unexplained radicular symptoms. The diagnosis of SIF can be helpful in cases involving concomitant multilevel lumbar spondylosis and neural foraminal stenosis.

Diabetic cervicobrachial radiculoplexopathy

Peripheral nervous system (PNS) damage is one of the most common complications of diabetes mellitus. There may be different PNS damage types that differ in clinical symptoms and pathogenesis. A clinical case of diabetic cervicobrachial radiculoplexopathy is presented for the first time in Russia. The paper discusses the clinical features of this type versus diabetic lumbosacral radiculoplexopathy, instrumental diagnosis of diabetic radiculoplexopathies, pathogenetic mechanisms of the disease, and treatment approaches. It shows the efficacy of alpha-lipoic acid supplementation in a patient with diabetic radiculoplexopathy.

Quantitative assessment of diabetic amyotrophy using magnetic resonance neurography-a case-control analysis.

To quantitatively characterize diabetic amyotrophy (DA), or diabetic lumbosacral radiculoplexopathy, and compare with controls using magnetic resonance neurography (MRN). Forty controls and 23 DA cases were analyzed qualitatively and quantitatively. Cross-sectional areas (CSAs) of bilateral L3 through S2 lumbosacral nerve roots, femoral nerves, and sciatic nerves (proximal and distal measurements) were measured. A linear model was used to assess the nerve location and case/control effect on angle-corrected CSAs. Intra- and inter-reader analysis was performed using intraclass correlation (ICC). In DA cases, abnormalities of the lumbosacral nerve roots, sciatic, femoral, and obturator nerves were seen in 21/23, 16/23, 21/23, and 9/23, respectively. Denervation abnormalities of multiple abdominopelvic muscles were seen. Quantitatively, the CSA of all measured LS plexus nerve roots and bilateral femoral nerves were significantly larger in DA cases vs. controls by 45% (95% CI, (30%, 49%); p< 0.001). The ICC was moderate for inter-rater analysis = 0.547 (95% CI, 0.456-0.626) and excellent for intra-rater analysis = 0.90 (95% CI, 0.89-92). Multifocal neuromuscular lesions related to diabetic amyotrophy were qualitatively and quantitatively detected on MRN. Qualitative abnormalities distinguished cases from controls, and nerve CSAs of cases were significantly larger than those of controls. Therefore, MRN may be employed as a non-invasive diagnostic tool for the evaluation of diabetic amyotrophy. • Qualitative abnormalities of lumbosacral nerve roots, their peripheral branches, and muscles are seen in DA. • The lumbosacral nerve roots and their peripheral branches in diabetic amyotrophy cases are significantly larger in cross-sectional area than non-diabetic subjects by 45% (95 CI, 30%, 49%; p < 0.001). • The ICC was moderate for inter-rater analysis = 0.547 (95% CI, 0.456-0.626) and excellent for intra-rater analysis = 0.90 (95% CI, 0.89-92).

Lumbosacral Radiculoplexopathy as the Initial Presentation of Lymphoma: A Report of Four Cases (P1.440)

Lumbosacral Radiculoplexopathy as the Initial Presentation of Lymphoma: A Report of Four Cases (P1.440)

Coordinated Cancer Rehabilitation for a Patient with Lumbosacral Radiculoplexopathy Due to Diffuse Large B-Cell Lymphoma: A Case Report

Coordinated Cancer Rehabilitation for a Patient with Lumbosacral Radiculoplexopathy Due to Diffuse Large B-Cell Lymphoma: A Case Report

Familial amyloid polyneuropathy associated with nodular lumbosacral radiculoplexopathy

Familial amyloid polyneuropathy associated with nodular lumbosacral radiculoplexopathy

O-(2-18F-Fluoroethyl)-L-Tyrosine PET Predicts Failure of Antiangiogenic Treatment in Patients with Recurrent High-Grade Glioma

The objective of this study was to compare MRI response assessment with metabolic O-(2-(18)F-fluoroethyl)-L-tyrosine ((18)F-FET) PET response evaluation during antiangiogenic treatment in patients with recurrent high-grade glioma (rHGG). Eleven patients with rHGG were treated biweekly with bevacizumab-irinotecan. MR images and (18)F-FET PET scans were obtained at baseline and at follow-up 8-12 wk after treatment onset. MRI treatment response was evaluated by T1/T2 volumetry according to response assessment in neurooncology (RANO) criteria. For (18)F-FET PET evaluation, an uptake reduction of more than 45% calculated with a standardized uptake value of more than 1.6 was defined as a metabolic response (receiver-operating-characteristic curve analysis). MRI and (18)F-FET PET volumetry results and response assessment were compared with each other and in relation to progression-free survival (PFS) and overall survival (OS). At follow-up, MR images showed partial response in 7 of 11 patients (64%), stable disease in 2 of 11 patients (18%), and tumor progression in 2 of 11 patients (18%). In contrast, (18)F-FET PET revealed 5 of 11 metabolic responders (46%) and 6 of 11 nonresponders (54%). MRI and (18)F-FET PET showed that responders survived significantly longer than did nonresponders (10.24 vs. 4.1 mo, P = 0.025, and 7.9 vs. 2.3 mo, P = 0.015, respectively). In 4 patients (36.4%), diagnosis according to RANO criteria and (18)F-FET PET was discordant. In these cases, PET was able to detect tumor progression earlier than was MRI. In rHGG patients undergoing antiangiogenic treatment, (18)F-FET PET seems to be predictive for treatment failure in that it contributes important information to response assessment based solely on MRI and RANO criteria.

Isolated amyloidosis presenting with lumbosacral radiculoplexopathy: description of two cases and pathogenic review

In this study, we present two cases of infiltrative, localized amyloidosis involving lumbosacral root and plexus, e.g., isolated amyloidomas. Rare and poorly understood amyloidomas may occur in both neurologic and non-neurologic tissues. The described cases emphasize potential for localized peripheral amyloidomas: (1) potential for associated lambda light chain lymphoplasmacytic lymphoma association; (2) e isolated amyloidosis without evidence for systemic plasma cell dyscrasia; (3) features suggestive of potential pathogenesis; and (4) discussion of treatment options including immunotherapy and resection. The limited literature and experience among other cases is described.

Neoplastic lumbosacral radiculoplexopathy in prostate cancer by direct perineural spread: An unusual entity

Neoplastic lumbosacral plexopathy occurs with some abdominal and pelvic malignancies. Patients present with severe pain radiating from the low back down to the lower extremities, and this progresses to weakness. Neoplastic lumbosacral plexopathy is virtually always associated with known malignancy or obvious pelvic metastatic disease. Uncommonly, prostate cancer can present as a lumbosacral plexopathy occurring through direct pelvic spread. We describe two cases of lumbosacral radiculoplexopathy from infiltrative prostate cancer without evidence of other pelvic or extraprostatic spread. The probable etiology of tumor spreading along prostatic nerves into the lumbosacral plexus (i.e., perineural spread) is discussed as are the potential mechanisms for this unusual mode of cancer dissemination.

Paraspinal Atrophy in Post-Radiation Lumbosacral Radiculoplexopathy

Paraspinal Atrophy in Post-Radiation Lumbosacral Radiculoplexopathy

Abstracts of the 8th Meeting of the Italian Peripheral Nerve Study Group: 2

Progressive brachial and lumbosacral radiculoplexopathies are well known, though infrequent, delayed complications of local irradiation. They present as slowly progressive, generally bilateral but asymmetric, limb weakness mainly affecting distal muscles. The pathogenesis is unknown although some authors supposed an autoimmune process or radio‐induced DNA changes. No treatment for this disease is currently available even if some benefits, though transient, have been reported after steroid treatment and more recently, high‐dose immunoglobulins (IVIg), suggesting a possible immune‐mediated pathogenesis. We previously reported on the beneficial effect of immunotherapies in two patients with postirradiation motor radiculoplexopathy. The first patient had a severe motor lumbosacral radiculoplexopathy starting 20 years after local radiotherapy for seminoma. He became able to walk and run with less waddling and to climb stairs without support after treatment with high‐dose intravenous steroids. The other patient had severe left brachial and bilateral lumbosacral plexopathies presenting 12 years after toracoascellar and lumbar irradiation for a Hodgkin lymphoma. She improved her right leg strength after one course of IVIg. After one year of continuous steroid therapy the first patient started to progressively deteriorate notwithstanding the subsequent administration of IVIg, resumed courses of steroids, plasma exchanges and azathioprine. The second patient, after one year of continuous IVIg treatment which led to stabilization without further improvement, was treated with high‐dose intravenous steroids and plasma exchange, with a marginal and transient amelioration followed by progressive worsening that was not halted by the resumption of IVIg. Both patients now suspended any therapy. In conclusion, in both our patients, immune therapies only induced a transient and short‐term benefit but did not affect the overall progression of the disease. These findings suggest that even if an immune or inflammatory component, possibly triggered by radiation, may be present in this condition, it does not probably represent the bulk of the pathological process.

POSTIRRADIATION LUMBOSACRAL RADICULOPLEXOPATHY: IMPROVEMENT AFTER IMMUNE THERAPY

A delayed progressive impairment of peripheral nervous system including brachial and lumbosacral radiculoplexopathy is a well‐known complication of local radiotherapy. No treatment for this infrequent complication is currently available. Recently, improvement after treatment with high dose immunoglobulin (IVIg) has been reported in some patients, suggesting either an immune‐mediated inflammatory nerve damage induced by irradiation or a dysimmune neuropathy (CIDP‐like) misdiagnosed as a postirradiation disease. We report on two patients who developed motor lumbosacral radiculoplexopathy several years after local radiotherapy. The first patient (ZA) is a 49 y.o. man developing a progressive proximal&gt;distal weakness and hypotrophy of lower limbs, 20 years after radiotherapy of lumbosacral region for seminoma. Electrophysiological studies showed markedly reduced motor conduction velocities (CV) and prolonged F‐wave latencies in lower limb nerves.The second patient (BF), is a 52 y.o. woman who developed progressive left brachial plexopathy and distal&gt;proximal weakness and hypotrophy of lower limbs 12 years after a first course of toracoascellar and lumbar irradiation for Hodgkin lymphoma followed by a second course of cervicoclavicular irradiation for tumor recurrence 7 years later. Electrophysiological studies showed markedly reduced CMAP amplitudes and proportionally reduced CV in motor nerves. No sensory impairment was detected in both patients. CSF protein was elevated in both patients while cells were normal. On the assumption of a possible dysimmune origin of the disease, patient ZA underwent high dose intravenous steroid treatment, while patient BF, who had previously deteriorated after steroids, was treated with IVIg. After treatment, patient ZA became able to walk with less waddling, to rise from the floor and climb stairs without support, and to run. Improvement was less consistent in patient BF, whose right leg strength improved even if she still needed bilateral support to walk. The improvement observed in both patients supports the hypothesis that, at least in some patients, an immune‐mediated mechanism may underlie postirradiation radiculoplexopathy.

Subacute Diabetic Proximal Neuropathy

To evaluate the clinical, electrophysiologic, autonomic, and neuropathologic characteristics and the natural history of subacute diabetic proximal neuropathy and its response to immunotherapy. For the 12-year period from 1983 to 1995, we conducted a retrospective review of medical records of Mayo Clinic patients with diabetes who had subacute onset and progression of proximal weakness. The responses of treated versus untreated patients were compared statistically. During the designated study period, 44 patients with subacute diabetic proximal neuropathy were encountered. Most patients were middle-aged or elderly, and no sex preponderance was noted. The proximal muscle weakness often was associated with reduced or absent lower extremity reflexes. Associated weight loss was a common finding. Frequently, patients had some evidence of demyelination on nerve conduction studies, but it invariably was accompanied by concomitant axonal degeneration. The cerebrospinal fluid protein concentration was usually increased. Diffuse and substantial autonomic failure was generally present. In most cases, a sural nerve biopsy specimen suggested demyelination, although evidence of an inflammatory infiltrate was less common. Of 12 patients who received treatment (with prednisone, intravenous immune globulin, or plasma exchange), 9 had improvement of their conditions, but 17 of 29 untreated patients (59%) with follow-up also eventually had improvement, albeit at a much slower rate. Improvement was usually incomplete. We suggest that the entity of subacute diabetic proximal neuropathy is an extensive and severe variant of bilateral lumbosacral radiculoplexopathy, with some features suggestive of an immune-mediated cause. It differs from chronic inflammatory demyelinating polyradiculoneuropathy in that most cases have a more restricted distribution and seem to be monophasic and self-limiting. The efficacy of immunotherapy is unproved, but such intervention may be considered in the severe and progressive cases or ones associated with severe neuropathic pain.

Magnetic coil stimulation of the human lumbosacral vertebral column: site of stimulation and clinical application

We describe the technique of magnetic coil (MC) stimulation of the lumbosacral roots and the possible site of stimulation in 22 control subjects, and the clinical usefulness of MC stimulation in 5 patients with low back pain. We observed 2 components in the compound muscle action potential of the soleus muscle following MC stimulation over the lumbosacral region. The second component had the physiological properties of the H reflex. The conduction time from the anterior horn cells of the lumbosacral spinal cord to the site of nerve root stimulation over the lumbosacral vertebral column was indirectly calculated as between 3.9 and 4.1 msec. Assuming a conduction velocity of 50 m/sec this would represent a distance of approximately 20 cm from the spinal motor neurons. Based on our control and patient data we conclude that the MC stimulation may be an useful technique for the diagnosis of lumbosacral radiculoplexopathy.

Differential diagnosis between radiation and tumor plexopathy of the pelvis.

We studied 20 patients with lumbosacral radiculoplexopathy from radiation treatment and 30 patients with plexus damage from pelvic malignancy. Indolent leg weakness occurred early in radiation disease, whereas pain marked the onset of tumor plexopathy. Eventually, all radiation cases had weakness, which was bilateral in most of them and painless in one-half of them. Tumor patients typically had unilateral weakness, which was painful in all of them. Radiation disease often resulted in serious neurologic disability. Of the tumor patients, 86% were dead within 3 1/2 years after onset of neurologic symptoms.