Painful lumbosacral plexopathy with elevated erythrocyte sedimentation rate: A treatable inflammatory syndrome

Abstract

Six patients had a syndrome of painful lumbosacral plexopathy and elevated erythrocyte sedimentation rate. Sural nerve biopsy in each case showed axonal degeneration and epineurial arterioles surrounded by mononuclear inflammatory cells. Differential fascicular involvement suggested an ischemic cause in three nerves, but no patient had a necrotizing vasculitis. None of the six patients had vasculitis or cancer. Three of the six were diabetic and were initially thought to have diabetic plexopathy, but deterioration continued despite control of the diabetes. These six patients appeared to have an ischemic neuropathy with an immunological basis. Five were treated with immunosuppressant drugs, and in four the plexopathy improved or was arrested. The pathogenesis is unclear, but postmortem findings in one case suggest that the syndrome does not stem from an underlying vasculitis.

Treatment of idiopathic lumbosacral plexopathy with intravenous immunoglobulin

“…Our findings support those of Bradley and colleagues, 2,16 namely that some patients with idiopathic LSP respond favorably to immunotherapy. Indeed, evidence suggests a causal relationship between immunotherapy and clinical improvement.…”

“…Bradley and colleagues described treatment of LSP with corticosteroids 2 and intravenous immunoglobulin (IVIg). 16 We describe treatment of 5 patients with idiopathic LSP with IVIg.…”

Local activation of the complement system in endoneurial microvessels of diabetic neuropathy

“…Other investigators observed similar mononuclear cell infiltrates in peripheral nerves [3,18,21,28,29,37,40]. Deposits of immunoglobulins and complement components, C3 and C4, in diabetic nerves were first described by Graham and Johnson [13].…”

Lumbosacral Plexus Neuropathy-Idiopathic Sciatic Neuropathy: A Case Report

“…Sadece bazı olgularda sedimentasyon yüksekliği bildirilmiştir (14). Serebrospinal sıvı analizi, hafif bir protein yük-sekliği dışında genellikle normaldir (2,4,15).…”

“…Biyopsi yapılan çalışmalarda belirgin mikrovaskülit olduğu görülmüştür (4). Bununla birlikte, olgu bildirilerinde hastalığın öncesinde bir üst solunum yolu infeksiyonu veya aşılama hikayesi olması (2,14,18) ve immünmodülatör tedavilere iyi yanıt vermesi (4,12,14,19) de LSRPN'nin otoimmün etyolojili bir hastalık olduğunu destekler bulgulardır. Sonuçta her iki nedenin de etyoloji üzerinde etkili olduğu düşünülmektedir (3,4,9).…”