Dyck P James B, Thaisetthawatkul Pariwat
Continuum (Minneap Minn). 2014 Oct;20(5 Peripheral Nervous System Disorders):1343-58. doi: 10.1212/01.CON.0000455877.60932.d3.
This article provides an up-to-date review of the clinical features and pathogenesis of different types of lumbosacral plexopathy and a clinical approach to their evaluation and management. Often, the pathologic involvement is not limited to the plexus and also involves the root and nerve levels. These conditions are called lumbosacral radiculoplexus neuropathies.
The pathophysiology of diabetic and nondiabetic lumbosacral radiculoplexus neuropathy has been elucidated; it is ischemic injury due to a perivascular inflammatory process and microvasculitis. The clinical and neurophysiologic features of these two entities have been found to be similar, consisting of acute or subacute onset of pain and paresthesia followed by profound motor weakness asymmetrically involving the lower limbs and associated with weight loss. A lower limb and motor predominant neuropathy without pain also occurs in diabetes mellitus and has been shown to be a form of diabetic lumbosacral radiculoplexus neuropathy and not diabetic chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The pathophysiology of some cases of postsurgical lumbosacral plexopathies has recently been shown also to be inflammatory from microvasculitis, and treatment with immunotherapy in a timely fashion may be desirable.
Many pathophysiologic processes, such as neoplastic, traumatic, infectious, radiation, and inflammatory/microvasculitic processes, can affect the lumbosacral plexus causing lumbosacral plexopathy. The clinical symptoms and signs depend on the part of the plexus involved and the temporal course. Management depends on the cause of the lumbosacral plexopathy. Many cases of lumbosacral plexopathy previously thought to be idiopathic have been shown to be caused by ischemic injury from microvasculitis; despite lack of evidence for efficacy in improving neurologic deficits, the authors of this article include immunotherapy in their management of patients with this condition.
本文对不同类型腰骶丛神经病的临床特征和发病机制进行了最新综述，并介绍了其评估和管理的临床方法。通常，病理累及不仅限于神经丛，还涉及神经根和神经节段。这些病症被称为腰骶神经根丛神经病。
糖尿病性和非糖尿病性腰骶神经根丛神经病的病理生理学已得到阐明；它是由血管周围炎症过程和微血管炎引起的缺血性损伤。已发现这两种疾病的临床和神经生理学特征相似，包括急性或亚急性起病的疼痛和感觉异常，随后是严重的运动无力，不对称地累及下肢并伴有体重减轻。糖尿病患者还会出现无疼痛的以下肢和运动为主的神经病，并且已证明这是糖尿病性腰骶神经根丛神经病的一种形式，而非糖尿病性慢性炎症性脱髓鞘性多发性神经根神经病（CIDP）。最近还表明，一些术后腰骶丛神经病病例的病理生理学也是由微血管炎引起的炎症，及时进行免疫治疗可能是可取的。
许多病理生理过程，如肿瘤、创伤、感染、辐射和炎症/微血管炎过程，都可影响腰骶丛，导致腰骶丛神经病。临床症状和体征取决于神经丛受累的部位和病程。管理取决于腰骶丛神经病的病因。许多以前被认为是特发性的腰骶丛神经病病例已被证明是由微血管炎引起的缺血性损伤所致；尽管缺乏改善神经功能缺损疗效的证据，但本文作者在对这种疾病患者的管理中仍纳入了免疫治疗。
