Marquardt Robert J, Li Yuebing
Department of Neurology, Neuromuscular Center, Neurological Institute, Cleveland Clinic Cleveland, OH.
J Clin Neuromuscul Dis. 2018 Jun;19(4):196-202. doi: 10.1097/CND.0000000000000213.
To evaluate the clinical, laboratory, and radiological features of 4 cases of biopsy-proven lymphomatous lumbosacral radiculoplexopathy.
Retrospective chart review.
All patients suffered from diffuse large B-cell lymphoma. A mean diagnostic delay of 10 months was encountered. Presenting symptoms in all 4 patients included back pain, radicular leg pain, and leg weakness, similar to spondylotic radiculopathy. Electrodiagnostic study showed axon loss radiculoplexopathy and magnetic resonance imaging of the lumbar spine or pelvis demonstrated nerve or nerve root enhancement. Increased uptake by lumbosacral roots/plexus on fluorodeoxyglucose-positron emission tomography aided diagnosis in 3 cases. Cytology was positive in 1 of 10 cerebrospinal fluid samples. Combined chemotherapy and radiation treatment led to clinicoradiological improvement, with residual neurological symptoms in all patients.
Lymphomatous lumbosacral radiculoplexopathy should be considered in patients with progressive lumbosacral radicular symptoms. Magnetic resonance imaging and fluorodeoxyglucose-positron emission tomography, but not cerebrospinal fluid, are helpful in achieving early diagnosis. Treatment responses seem favorable.
评估4例经活检证实的淋巴瘤性腰骶神经根丛病的临床、实验室及影像学特征。
回顾性病历审查。
所有患者均患有弥漫性大B细胞淋巴瘤。平均诊断延迟10个月。所有4例患者的主要症状包括背痛、放射性腿痛和腿部无力，类似于神经根型颈椎病。电诊断研究显示轴索性神经根丛病，腰椎或骨盆的磁共振成像显示神经或神经根强化。18F-氟脱氧葡萄糖正电子发射断层扫描显示腰骶神经根/丛摄取增加，对3例患者的诊断有帮助。10份脑脊液样本中有1份细胞学检查呈阳性。联合化疗和放疗使临床和影像学得到改善，所有患者均有残留神经症状。
对于有进行性腰骶神经根症状的患者，应考虑淋巴瘤性腰骶神经根丛病。磁共振成像和18F-氟脱氧葡萄糖正电子发射断层扫描有助于早期诊断，而脑脊液检查无助于此。治疗反应似乎良好。
