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Final Program


Final Program

1240 - Idiopathic Lumbosacral Plexopathy: A Case Study

Friday, February 28, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • BH

    Benjamin Headley, MD

    Resident
    University of Kentucky Department of Physical Medicine and Rehabilitation
    Lexington, Kentucky, United States

    • Co-Author(s)

  • MP

    Michael C. Parrott, DO

    Assistant Professor
    University of Kentucky
    Lexington, Kentucky, United States

Case Diagnosis: Idiopathic Case of Lumbosacral Plexopathy

Case Description: The patient is a 46-year-old Haitian woman referred to PM&R clinic. She had presented with left lower extremity (LLE) weakness for one year, associated with left knee neuropathic pain. The symptoms developed without acute traumatic inciting event, and she maintained preserved bowel and bladder function, suggesting a peripheral nerve injury.

Discussions:

Management: At the PM&R Outpatient MSK clinic, the patient reported focal lack of strength, paresthesia, and decreased sensation in the L2-S2 dermatomes with foot drop. She was independent with ADLs. Prior MRI of the lumbar spine and plain knee radiographs showed no acute abnormalities, thus, the following workup was conducted:


  • Appointment 1: NCS/EMG and MRI pelvis ordered

  • Appointment 2: Severe lumbosacral plexopathy with minimal reinnervation was confirmed. MRI pelvis showed concerns for myositis vs. subacute/chronic denervation prompting CT chest, abdomen, pelvis, and referral to a neuromuscular specialist. Patient did not tolerate KAFO

  • Appointment 3: CT chest: concentric pulmonary nodules, considering TB, Amyloidosis, and Sarcoidosis. Basic labs obtained, and pulmonary referral was made.


Consulting Services:


  • Neuromuscular: Vasculitis panel, CK, heavy metals, motor neuropathy panel, paraneoplastic panel, TSH, PTH – no significant findings. Nerve biopsy was discussed.

  • Pulmonology: Multiple nodules found on imaging: low malignancy risk. Decision made to stop following nodules.



Conclusions:

This case underscores the importance of a broad differential diagnosis in atraumatic lumbosacral plexopathy and rapid involvement of subspecialists for potential neoplastic origins. Further workup, including MRI of the lumbosacral plexus and possible nerve biopsy, may prove to be essential to determine the underlying etiology and guide treatment.