From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.).
Radiology. 2022 Oct;305(1):239-241. doi: 10.1148/radiol.212606.
A 49-year-old man presented with right foot drop, bilateral cruralgia mainly on the left side, and genital and perianal hypoesthesia, which started suddenly 12 days before. After onset of symptoms, the patient also experienced an accidental fall at home, resulting in a left fibular fracture, which was treated with reduction and with seven-hole plate Synthes Locking Compression Plate at the orthopedic clinic. The neurologic examination showed paresthesias on the posterior aspect of both thighs and crural regions that was worse on the left side, hypoesthesia in the L5 root region on the right side, and right foot drop. There was no urinary retention or fecal incontinence. The patient denied past surgery, back trauma, heavy manual labor, hypermobility, or any other remarkable medical history. The patient was afebrile. Laboratory results on the 1st day of hospitalization showed increased C-reactive protein level (0.62 mg/dL; reference range, 0.0-0.5 mg/dL), elevated erythrocyte sedimentation rate (60 mm/h; reference range, 0-20 mm/h), and increased aspartate transaminase (38 U/L [0.63 μkat/L]; reference range, 0-31 U/L [0-0.52 μkat/L]), alanine transaminase (70 U/L [1.17 μkat/L]; reference range, 0-31 U/L [0-0.52 μkat/L]), and high lymphocyte (4.55 × 10/μL; reference range, [1.0-3.0] × 10/μL), and neutrophil (8.79 × 10/μL; reference range, [2.0-7.0] × 10/μL) levels. Absence of coagulopathy was demonstrated by normal coagulation values (international normalized ratio, 1.19; reference value, 0.80-1.25; activated partial thromboplastin time ratio, 0.88 second; reference range, 0.79-1.27 seconds). Electroneurography showed marked hypoevocable F response in the right tibia. Electromyography indicated severe reduction of muscle recruitment pertaining to right L4, L5, and S1 nerve territory and, to a lesser extent, of muscles pertaining to L3 territory bilaterally in the absence of spontaneous denervation. Unenhanced CT (Fig 1) and contrast-enhanced MRI of the lumbosacral spine were performed (Figs 2, 3).
一位 49 岁男性，因右侧足下垂、双侧小腿疼痛主要位于左侧以及生殖器和肛周感觉减退，于 12 天前突然起病。起病后，患者还在家中意外跌倒，导致左侧腓骨骨折，在骨科诊所接受了复位和七孔钢板 Synthes Locking Compression Plate 固定治疗。神经系统检查显示双侧大腿和小腿后侧有感觉异常，左侧更明显，右侧右侧 L5 神经根区感觉减退，右侧足下垂。无尿潴留或大便失禁。患者否认既往手术、背部创伤、重体力劳动、活动过度或任何其他显著病史。患者无发热。住院第 1 天的实验室检查结果显示 C 反应蛋白水平升高（0.62mg/dL；参考范围 0.0-0.5mg/dL）、红细胞沉降率升高（60mm/h；参考范围 0-20mm/h）、天门冬氨酸转氨酶升高（38U/L[0.63μkat/L]；参考范围 0-31U/L[0-0.52μkat/L]）、丙氨酸转氨酶升高（70U/L[1.17μkat/L]；参考范围 0-31U/L[0-0.52μkat/L]）和高淋巴细胞计数（4.55×10/μL；参考范围[1.0-3.0]×10/μL），中性粒细胞计数（8.79×10/μL；参考范围[2.0-7.0]×10/μL）。正常凝血值（国际标准化比值 1.19；参考值 0.80-1.25；活化部分凝血活酶时间比值 0.88 秒；参考范围 0.79-1.27 秒）表明无凝血障碍。神经电图显示右侧胫骨 F 波反应明显减弱。肌电图显示右侧 L4、L5 和 S1 神经支配区肌肉募集严重减少，双侧 L3 神经支配区肌肉募集程度较轻，但无自发性去神经支配。进行了腰骶脊柱的非增强 CT（图 1）和对比增强 MRI（图 2、3）检查。
