2021, 3(1):23-25 e-ISSN: 2674-7103

DOI: 10.37085/jmmv3.n1.2021.pp.23-25

Jornal Memorial

Medicina

Image in Medicine

Radiological aspects of idiopathic lumbosacral plexitis

Artêmio José Araruna Dias

Júlio César Tavares Marques

Luís Felipe Gonçalves de Lima

Nilson

Batista Lemos

Andrey Maia Silva Diniz

Otávio da Cunha Ferreira Neto

Keyvid dos Santos Pereira

Hildo Rocha Cirne de Azevedo Filho

4,5

Luiz Severo Bem Junior

4,5

UNIFACISA, Campina Grande, Brazil

Federal University of Paraiba, João Pessoa, Brazil

Catholic University of Pernambuco, Recife, Brazil

Department of Neurosurgery, Hospital da Restauração, Recife, Brazil

Neuroscience Post-Graduate Program, Federal University of Pernambuco, Recife, Brazil

Abstract

Idiopathic Lumbosacral Plexitis is a disease that does not have denitive causes but even starts to

be studied by Sander Evans et al. in 1981 hypotheses were forward related to viral infections,

vaccines and heterologous serum. Although more recently, studies have showed that the disease

can develop without immunological history. Multiple roots and nerves can be affected, and it

can be bilateral. The differential diagnosis of other pathologies must involve research for tumors,

traumas, and diabetes. The ndings of the disease include: autoimmune demyelination and

vasculitis with axonal lesion. The clinical condition is characterized by intensive pain, paresis,

hypoesthesia in lower members, and a limping gait. The prognosis is positive; however do not

have a complete remission without squeals. The treatment has not been dened but is common

to uses corticosteroids and immunoglobulin.

Artêmio José Araruna Dias

ararunadias@gmail.com

Edited by

Juliana Ramos Andrade

Keywords:

Lumbosacral plexopathy

non-diabetic lumbosacral radiculo-

plexus neuropathy

autoimmune demyelination

Received: June 27, 2021

Accepted: July 27, 2021

ASAA

Dias AJ, Lima LFG, Lemos NB, Diniz AMS, Ferreira Neto OC, Pereira KS, Azevedo Filho RC, Bem Junior LS

Radiological aspects of idiopathic lumbosacral plexitis

Introduction

diopathic lumbosacral plexitis (ILP) is a rare acute or sub-

acute neuropathic syndrome affecting mainly motor lower

limb. Multiple levels of lumbosacral plexus, nerve roots and

their distal nerves can be affected. This is an idiopathic dis-

order that are clinically characterized by weakness; atrophy

of the thigh muscles; and severe asymmetric leg pain. The

another symptoms includes hypoesthesia; allodynia and

autonomic dysfunction.

This syndrome is usually monophasic, despite that the recovery

is not complete, and the patients have sequelae. Have similar

features between (ILP) and diabetic lumbosacral radiculoplex-

us neurophaty (DLRPN). The neurological characteristics are

almost similar, although the pathological source is different.

The pathogenesis and etiology is uncertain until now, but

studies demonstrates alterations involves ber degeneration,

injury neuroma, focal thickening and microvascular ischemia.

No treatment has been proved until now. Actually is common

to uses anti-inammatory and immunomodulatory to reduces

the symptomatology and brakes progression of the disease.

To control another symptom like depression and anxiety,

antidepressants can be useful. The physiotherapy can be

applied to reduce movement limits and pain.

Images granted by Hospital of Restauração, Recife-PE

Image analysis

Magnetic resonance imaging (MRI) is the most important

exam of neuroimaging in DLRPN and ILP. It is possible to

analyze the anatomical component and correlate it with other

ndings from other exams, such as electroneuromyography,

establishing an effective complementary exam.

In MRI, it is possible to assess other probable etiologies for

the symptomatic picture presented by the patient, identifying

if there are tumors, traumatic damage, compression sites, and

inammation. It is also possible to analyze characteristics of

each etiology, in addition to the extent of the lesion, its path,

in addition to evaluating the appearance of the muscles and

associated bone framework.

A classic and common differential diagnosis is the clinical

distinction between idiopathic lumbosacral plexopathy and

radiculopathy due to disc degeneration, which is sometimes

challenging, thus requiring imaging exams that can clarify.

In the image presented, there is no evidence of component

lesions disc or degeneration by facet arthropathy.

The MRI is so useful to shows slightly to moderately increased

T2 signal, gadolinium enhancement, or enlargement of the

nerve roots, plexus, and peripheral nerves.

In the image we observed revealed hyper signal in the L5 root

on the right with Electroneuromyography compatible with ipsi-

lateral root damage. This hyper signal denotes an idiopathic

inammation, since it has no evidence of demyelinating lesion;

neuropraxia; axonotmesis; neurotmesis.

Neuropathy associated with paraproteins or paraneoplastics

were also ruled out, as there were no ndings of such etiol-

ogies in the image.

Furthermore, it is possible to see that there is no nerve com-

pression that justies the clinical picture and the evidenced

inammation. It is not possible to observe the presence of

tumors, abscesses or traumatic lesions in the path of the nerve

and its root or in the tissues adjacent to them.

ASAA

Dias AJ, Lima LFG, Lemos NB, Diniz AMS, Ferreira Neto OC, Pereira KS, Azevedo Filho RC, Bem Junior LS

Radiological aspects of idiopathic lumbosacral plexitis

T1-weighted sequences with 2-4 mm cut thickness and high

resolution are one of the bests techniques for demonstrating

the fascicular pattern of the normal nerve, and the anatomical

structures around the nerve.

Suppressed fat T2-weighted are very useful because have

a sensitive detection of different nervous diseases. The ad-

ministration of intravenous contrast agents can be utilized

to facilitate the image analysis. This is very useful to verify

an inammatory pathology and neoplastic naturopathies.

Robbins et. Al, 2016, identied different diffuse inammatory

plexopathies in their series, including heroin-associated vas-

culitic plexopathy and diabetic lumbosacral plexitis, multiple

mononeuritis, hepatitis C-associated vasculitis, sarcoidosis,

neuro-associated vasculitic plexitis, amyloidosis restricted to

the plexus and others.

In view of the careful analysis and investigation of the images,

as well as the clinical picture and the history collected from

the patient's anamnesis, it was postulated as an Idiopath-

ic Plexopathy. The main differential diagnosis is Diabetic

Plexopathy, which cannot be excluded by MRI, however the

patient did not have diabetes, nor did he have a uctuation

in the glycemic rate.

However, it is worth noting that the role of MRI in this pa-

thology is not to complete the diagnosis, as it is classied

as idiopathic. It was essential to correlate with the patient's

history, neurological examination and other tests (laboratory

and electromyography).

Conclusion

The sequels and the clinical condition of the Lumbosacral

plexopathy make that disease an important to be studied

and researched for the next years. Nowadays does not have

a consensus of the treatment and the diagnosis is not easy

and not common. The neuroimaging exams, clinical history

and physical examination are so helpful to nd the diagnosis.

Artêmio José Araruna Dias

https://orcid.org/0000-0002-3565-0586

Júlio César Tavares Marques

https://orcid.org/0000-0002-4600-4731

Luís Felipe Gonçalves de Lima

https://orcid.org/0000-0002-0130-0625

Nilson Batista Lemos

https://orcid.org/0000-0002-2331-6871

Andrey Maia Silva Diniz

https://orcid.org/0000-0002-5572-7018

Otávio da Cunha Ferreira Neto

https://orcid.org/0000-0003-0517-0212

Keyvid dos Santos Pereira

https://orcid.org/0000-0003-1842-8956

Hildo Rocha Cirne de Azevedo Filho

https://orcid.org/0000-0002-1555-3578

Luiz Severo Bem Junior

https://orcid.org/0000-0002-0835-5995

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