Use of MRI in diabetic lumbosacral radiculoplexus neuropathy: case report and review of the literature

McCormack, Erin; Alam, Meher; Erickson, Nicholas; Cherrick, Abraham; Powell, Emily; Sherman, Jonathan H.

doi:10.1007/s00701-018-3664-z

Cited by 10 publications

(5 citation statements)

References 9 publications

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“… 14 15 However, MRI of the lumbosacral plexus in DLRPN patients revealed inflammation within bilateral sciatic and femoral nerves, with a T2 signal without enhancement. 16 Some studies have also found that the early application of immunosuppression may hasten recovery and improve symptoms. 17 The pathology of DLRPN was typical of that of ischemic injury due to microvasculitis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Significance of MRI Contrast Enhancement of the Oculomotor Nerve in Ischemic Isolated Oculomotor Nerve Palsy

et al. 2020

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Background and Purpose Contrast enhancement of the oculomotor nerve in MRI was recently noticed in patients with clinical ischemic isolated oculomotor nerve palsy (iIONP). The opinions about whether this is a sign of inflammation and whether or not to administer steroids vary between doctors. The study aimed to determine the associations between this enhancement and vascular-disease risk factors (VRFs) and inflammatory factors in iIONP patients. Methods The study recruited patients who had experienced iIONP during the previous 2 years. They were divided into groups A and B based on whether or not they exhibited an enhanced oculomotor nerve in MRI of the cavernous sinus using thin-section, fat-suppressed, and contrast-enhanced sequences. VRFs, inflammatory factors, and improvement scores were compared between the two groups. Results Most (71.1%) of the 45 included iIONP patients had enhanced oculomotor nerves in MRI. VRFs, periorbital pain, elevated C-reactive protein and erythrocyte sedimentation rate, the neutrophil-to-lymphocyte ratio, and the platelet-to-lymphocyte ratio were not significantly associated with the enhancement. Four of the five patients in group A exhibited an elevated cerebrospinal fluid (CSF) IgG synthesis rate. The improvement score of eight patients who received 80 mg of methylprednisolone in addition to the routine therapy was not significantly different from the scores of the other patients (p=0.485). Conclusions More than half of the iIONP patients had an enhanced oculomotor nerve in MRI. A few of them also had elevated CSF IgG synthesis rate, but no further evidence for inflammation was found. The administration of steroids seemed to have no benefit other than increasing the blood glucose level.

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Section: Discussionmentioning

confidence: 99%

Clinical Significance of MRI Contrast Enhancement of the Oculomotor Nerve in Ischemic Isolated Oculomotor Nerve Palsy

et al. 2020

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“…The review was not designed to capture all the relevant articles but to be highly representative of the existing literature involving diabetic amyotrophy. The search resulted in selection of 20 case report articles [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] and 8 observational case-series, 2,23-29 from which data was available for a total of 115 cases.…”

Section: Methodsmentioning

confidence: 99%

Diabetic Amyotrophy: From the Basics to the Bedside

Albers

Jacobson

Smyth

2020

EMJ

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Diabetic amyotrophy is a rare complication of diabetes compared to distal symmetric polyneuropathy, but can occasionally be encountered in clinical practice, particularly as the incidence of diabetes increases. The distinctive history of unilateral neuropathic symptoms followed rapidly by atrophy and weakness is typical of the disorder. This complication most commonly occurs in cases of well-controlled Type 2 diabetes mellitus. While the underlying pathophysiology is known to be microvasculitic in nature, the diagnosis is often based on clinical and electrodiagnostic grounds and tissue biopsy is not typically performed. Attempts at corticosteroid administration during immunotherapy should be carefully considered on a patient-by-patient basis. Better recognition of this disorder is likely to result in more rapid diagnosis, counselling, and subspecialty referral.

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“…5 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. 6 In the image presented, there is no evidence of component lesions disc or degeneration by facet arthropathy.…”

Section: Image Analysismentioning

confidence: 86%

Radiological aspects of idiopathic lumbosacral plexitis

Dias

Marques

Lima

et al. 2021

jmm

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Idiopathic Lumbosacral Plexitis is a disease that do not have definitive causes but even starts to be studied by Sander Evans et al. in 1981 hypotheses were put 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 are affected and it can be bilateral. The diferential diagnosis of other pathologies must involves research for tumours, traumas and diabetes. The findings of the disease include: autoimmune demyelination and vasculitis with axonal lesion. The clinicalconditionare characterized by intensive pain, paresis, hypoesthesia in lower members, and a limping gait. The prognosis is positive, however do not have a completely remission without squeals. The treatment has not been defined but is common to uses corticosteroids and immunoglobulin.

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Use of MRI in diabetic lumbosacral radiculoplexus neuropathy: case report and review of the literature

Cited by 10 publications

References 9 publications

Clinical Significance of MRI Contrast Enhancement of the Oculomotor Nerve in Ischemic Isolated Oculomotor Nerve Palsy

Clinical Significance of MRI Contrast Enhancement of the Oculomotor Nerve in Ischemic Isolated Oculomotor Nerve Palsy

Diabetic Amyotrophy: From the Basics to the Bedside

Radiological aspects of idiopathic lumbosacral plexitis

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