Ehler Edvard, Vyšata Oldřich, Včelák Radek, Pazdera Ladislav
From the Department of Neurology (EE), Regional Hospital and Faculty of Health Studies, University of Pardubice; Department of Neurology (OV), University Hospital Hradec Králové; Department of Radiology (RV), Regional Hospital Pardubice; and Department of Neurology (LP), Health Centre Rychnov nad Kneznou, Czech Republic.
Medicine (Baltimore). 2015 May;94(17):e766. doi: 10.1097/MD.0000000000000766.
Patients frequently suffer from lumbosacral plexus disorder. When conducting a neurological examination, it is essential to assess the extent of muscle paresis, sensory disorder distribution, pain occurrence, and blocked spine. An electromyography (EMG) can confirm axonal lesions and their severity and extent, root affliction (including dorsal branches), and disorders of motor and sensory fiber conduction. Imaging examination, particularly gadolinium magnetic resonance imaging (MRI) examination, ensues. Cerebrospinal fluid examination is of diagnostic importance with radiculopathy, neuroinfections, and for evidence of immunoglobulin synthesis. Differential diagnostics of lumbosacral plexopathy (LSP) include metabolic, oncological, inflammatory, ischemic, and autoimmune disorders.In the presented case study, a 64-year-old man developed an acute onset of painful LSP with a specific EMG finding, MRI showing evidence of plexus affliction but not in the proximal part of the roots. Painful plexopathy presented itself with severe muscle paresis in the femoral nerve and the obturator nerve innervation areas, and gradual remission occurred after 3 months. Autoimmune origin of painful LSP is presumed.We describe a rare case of patient with painful lumbar plexopathy, with EMG findings of axonal type, we suppose of autoimmune etiology.
患者经常患有腰骶丛疾病。进行神经学检查时,评估肌肉麻痹程度、感觉障碍分布、疼痛发生情况以及脊柱梗阻至关重要。肌电图(EMG)可以确认轴索性病变及其严重程度和范围、神经根受累情况(包括背支)以及运动和感觉纤维传导障碍。随后进行影像学检查,尤其是钆增强磁共振成像(MRI)检查。脑脊液检查对于神经根病、神经感染以及免疫球蛋白合成证据具有诊断意义。腰骶丛病变(LSP)的鉴别诊断包括代谢性、肿瘤性、炎症性、缺血性和自身免疫性疾病。在本病例研究中,一名64岁男性急性发作疼痛性LSP,肌电图有特定表现,MRI显示有丛受累证据,但神经根近端未受累。疼痛性丛病变表现为股神经和闭孔神经支配区域严重肌肉麻痹,3个月后逐渐缓解。推测疼痛性LSP的自身免疫起源。我们描述了一例罕见的疼痛性腰丛病变患者,肌电图表现为轴索型,推测其病因是自身免疫性的。