Left Lower Extremity Weakness Research Articles

Lumbar-sacral radiculopathy secondary to intraspinal synovial cyst

Objective: The presentation of a patient with acute low back pain and distal radiation to the lower extremities is often attributed to a herniated nucleus pulposus (NHP). The purpose of this report is to illustrate how an intraspinal lumbar synovial cyst can have a similar presentation. Case Presentation: A 52-year-old man presented with low back pain with left lower extremity weakness and distal radiation. An electrodiagnostic evaluation was consistent with lumbar-sacral radiculopathy. Computed tomography and magnetic resonance imaging showed a synovial cyst of the L4-5 facet joint. Intervention: The patient underwent a L4-L5 laminotomy, synovial cyst excision, and decompression of the L5 nerve root. Results: There were no postoperative complications. The patient had residual left lower extremity numbness but gradually regained the strength of his left lower extremity. Intraspinal synovial cyst can mimic the clinical pattern of NHP. Conclusion: An intraspinal lumbar synovial cyst can present with symptoms of nerve root compression. Given the presentation of lumbar-sacral radicular symptoms such as radiating pain, muscle weakness, and numbness, surgical excision of the lumbar synovial cyst remains the definitive treatment of choice.

Breast cancer with osseous metastasis and herniated lumbar disc A cautionary tale

A 39-year-old white woman with breast cancer, metastatic to her skeleton, developed low back and left lower extremity pain and lower extremity weakness. A bone scan evidenced increased radioisotope activity in her lumbar spine and a computed tomography (CT) scan showed a lesion of the L4 vertebra. Because of myelographic findings of a extradural defect at the L4-5 disc space and the possibility of a herniated disc causing the patient's pain and neurologic deficit in her lower extremities, the patient underwent surgery and a large herniated L4-5 disc was removed. As a consequence, the patient experienced relief of the lower extremity pain and return of strength in her lower extremities. She died a considerable time later from refractory hypercalcemia.

Dissecting thoracic aortic aneurysm in a 16-year-old

A 16-year-old boy presented with a one-hour history of left lower extremity pain and weakness, and was found to have a dissecting aortic aneurysm. The patient underwent emergency aortic angiography and immediate reparative aortic aneurysm surgery. He died on the fifth postoperative day. Because the majority of cases occur in the fifth to sixth decade of life, dissecting aortic aneurysm is a rare and usually fatal condition in adolescents. Potentially favorable outcome in this age group depends on prompt diagnosis and immediate medical and surgical intervention.

6 Transfusion Support for Haemophiliacs

Weakness is a common presentation in the emergency department (ED). Asymmetric weakness or weakness that appears not to follow an anatomical pattern is a less common occurrence. Acute flaccid paralysis with no signs of meningoencephalitis is one of the more uncommon presentations of West Nile virus (WNV). Patient may complain of an acute onset of severe weakness, or even paralysis, in one or multiple limbs with no sensory deficits. This weakness is caused by injury to the anterior horn cells of the spinal cord. We present a case of acute asymmetric flaccid paralysis with preserved sensory responses that was eventually diagnosed as neuroinvasive WNV infection.A 31-year-old male with no medical history presented with complaints of left lower and right upper extremity weakness. Computed tomography scan was negative and multiple other studies were performed in the ED. Eventually, he was admitted to the hospital and was found to have decreased motor amplitudes, severely reduced motor neuron recruitment, and denervation on electrodiagnostic study. Cerebrospinal fluid specimen tested positive for WNV immunoglobulin (Ig) G and IgM antibodies.Acute asymmetric flaccid paralysis with no signs of viremia or meningoencephalitis is an unusual presentation of WNV infection. WNV should be included in the differential for patients with asymmetric weakness, especially in the summer months in areas with large mosquito populations.

Autopsy case of progressive spinal muscular atrophy

A japanese woman aged 31 fell in November, 1957, striking her left thigh and then noted ensuing local pain. Threem onths later, she became aware of weakness of left lower extremity. She was admitted in February, 1959, with chief complaints of progressive weakness of the extremity, difficulty in walking and inability to stand and to raise her arms., over the sholder. Examination revealed atrophy of most skeletal muscle groups. She died of respiratory failure 19 months after the onset of ailment. The past and family history were not contributory.necropsy revealed generalized atrophy of the trunk and extremity musculature. No gross abnomality was found in external configulation and in various cut sections of the brain and spinal cord.Microscopically, there was an evidence of cellular degeneration of ventral horn cells in all the section of spinal cord associated with a glial tissue replacement in the damaged area. A mild degree of myelin sheath degeneration was observed in the anterolateral colums. Sections of medulla revealed similar involvement of hypoglossal nuclei. Sections of skeletal muscles disclosed atrophic muscle fibers separated by cluster of normal appearing fibers.The pathologic picture of this case was characterized by muscular denervation atrophy and degenerative processes of the central nervous system with selective involvement of the lower motor neuron which conformed classic description of the progressive spinal muscular atrophy of Duchenne Aran type.