Painful Lumbosacral Plexopathy

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. (Medicine 94(17):e766) Abbreviations: CSF = cerebrospinal fluid, DTP = diphtheria, tetanus, pertussis, EMG = electromyography, LSP = lumbosacral plexopathy, MRI = magnetic resonance imaging. INTRODUCTION I n lumbar plexus disorders, symptoms appear in various extents of the lower torso, pelvis, and legs. Lumbosacral plexopathy (LSP) occurs relatively frequently. It represents a serious diagnostic challenge because of the extent of affliction and determining the cause, as well as differential diagnostics. , Radek Včelák, MD, and Ladislav Pazdera, MD