Muscle hypertrophy of the lower leg caused by L5 radiculopathy

Kottlors, Michael; Klaus, Mueller; Kirschner, Janbernd; Glocker, Franz Xaver

doi:10.1016/j.jbspin.2009.01.009

Cited by 8 publications

(3 citation statements)

References 11 publications

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“…8 This condition has also been reported with L5 radiculopathy. 9 Yet, there were essential differences in the current case which eliminated similar diagnoses. First, levels of CPK, lactate dehydrogenase and the more muscle-specific aldolase were all normal.…”

Section: Discussionmentioning

confidence: 80%

“…1,4 Moreover, an association has never been reported with lower limb oedema, although there are some reports of LDH cases presenting with swollen calves. [6][7][8][9] Khan et al reported a patient with a swollen calf who was diagnosed with LDH of the L5-S1 intervertebral disc after deep vein thrombosis and a local tumour were ruled out; electromyography and a muscle biopsy indicated inflammatory myopathy, suggesting a diagnosis of radiculopathy/calf hypertrophy syndrome. 6 A similar case attributed to radiculopathy/calf hypertrophy syndrome has also been described.…”

Section: Discussionmentioning

confidence: 99%

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Pitting Oedema in a Patient with Lumbar Disc Herniation: Case report of an unusual association

Sadeghian

Motiei-Langroudi

2018

Sultan Qaboos Univ Med J

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Oedema refers to the excessive accumulation of fluid within intercellular tissues as a result of disequilibrium between the capillary hydrostatic and oncotic pressure gradients. Lumbar disc herniation (LDH) commonly causes lower back pain and radicular leg pain. We report a 57-year-old female who presented to the neurosurgery clinic of the Bam University of Medical Sciences, Bam, Iran, in 2015 with pain and pitting oedema in the bilateral lower extremities. Magnetic resonance imaging confirmed a diagnosis of LDH of the L3-L4 and L4-L5 vertebrae. The patient subsequently underwent a bilateral laminotomy and foraminotomy of the involved vertebrae to relieve her pain. Following the surgery, there was a complete resolution of the LDH-related symptoms as well as the oedema. Although LDH has never before been associated with oedema, it may nevertheless cause lower limb oedema in exceptional and rare cases, as highlighted in this patient.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Pitting Oedema in a Patient with Lumbar Disc Herniation: Case report of an unusual association

Sadeghian

Motiei-Langroudi

2018

Sultan Qaboos Univ Med J

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“…Proposed mechanism responsible for overactivity of the affected muscle included ephaptic transmission among nerve fibers at the root compression or type I fiber hypertrophy in response to the complex repetitive discharges. [8910]…”

Section: Discussionmentioning

confidence: 99%

Focal neuromyotonia as a presenting feature of lumbosacral radiculopathy

Raut

Garg

Chaudhari

et al. 2013

Ann Indian Acad Neurol

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Neuromyotonia is characterized by motor, sensory, and autonomic features along with characteristic electrophysiologic findings, resulting from hyperexcitability of the peripheral nerves. We describe the case of a 36-year-old man, who presented with the disabling symptoms suggestive of focal neuromyotonia involving both the lower limbs. His neurological examination revealed continuous rippling of both the calf muscles with normal power, reflexes, and sensory examination. Electrophysiology revealed spontaneous activity in the form of doublets, triplets, and neuromyotonic discharges along with the neurogenic motor unit potentials in bilateral L5, S1 innervated muscles. Magnetic resonance imaging lumbosacral spine revealed lumbar intervertebral disc protrusion with severe foraminal and spinal canal stenosis. Patient had good response to steroids and carbamazepine. The disabling focal neuromyotonia, occurring as a result of chronic active radiculopathy, brought the patient to medical attention. Patient responded to medical management.

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Muscle hypertrophy following acquired neurogenic injury: systematic review and analysis of existing literature

Strano,

Bosco,

Laurini

et al. 2024

Ann Clin Transl Neurol

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ObjectivesNeurogenic muscle hypertrophy (NMH) is a rare condition characterized by focal muscle hypertrophy caused by chronic partial nervous injury. Given its infrequency, underlying mechanisms remain poorly understood. Inspired by two clinical cases, we conducted a systematic review to gain insights into the different aspects of NMH.MethodsWe systematically searched online databases up until May 30, 2023, for reports of muscle hypertrophy attributed to acquired neurogenic factors. We conducted an exploratory analysis to identify commonly associated features. We also report two representative clinical cases.ResultsOur search identified 63 reports, describing 93 NMH cases, to which we added our two cases. NMH predominantly affects patients with compressive radiculopathy (68.4%), negligible muscular weakness (93.3%), and a chronic increase in muscle bulk. A striking finding in most neurophysiological studies (60.0%) is profuse spontaneous discharges, often hindering the analysis of voluntary traces. Some patients exhibited features consistent with more significant muscle damage, including higher creatine phosphokinase levels, muscle pain, and inflammatory muscle infiltration. These patients are sometimes referred to in literature as “focal myositis.” Treatment encompassed corticosteroid, Botulinum Toxin A, decompressive surgery, antiepileptic medications, and nerve blocks, demonstrating varying degrees of efficacy. Botulinum Toxin A yielded the most favorable response in terms of reducing spontaneous discharges.InterpretationThis systematic review aims to provide a clear description and categorization of this uncommon presentation of an often‐overlooked neurological disorder. Though questions remain about the underlying mechanism, evidence suggests that aberrant fiber overstimulation along with increased workload that promotes focal damage may result in muscle hypertrophy. This may serve as a guide for therapeutic interventions.

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Muscle hypertrophy of the lower leg caused by L5 radiculopathy

Cited by 8 publications

References 11 publications

Pitting Oedema in a Patient with Lumbar Disc Herniation: Case report of an unusual association

Pitting Oedema in a Patient with Lumbar Disc Herniation: Case report of an unusual association

Focal neuromyotonia as a presenting feature of lumbosacral radiculopathy

Muscle hypertrophy following acquired neurogenic injury: systematic review and analysis of existing literature

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