Idiopathic recurrent lumbosacral plexopathy (clinical case)

Abstract

Idiopathic lumbosacral plexopathy is a disease characterized by lesions of the lumbar and/or sacral plexus that are not related to trauma, mass effect, or diabetes mellitus. Several cases of recurrent lumbosacral plexopathy have been described in the literature, but we found no indication for a painless form of recurrence, which is the reason why this clinical case was described. Aim. The aim of the study was to use the example of clinical case of a patient with idiopathic recurrent lumbosacral plexopathy to analyze the course of the disease depending on management tactics. Material and methods. A 49-year-old female patient was admitted to the emergency neurology department with complaints of weakness, pain and sensory disturbances in the right leg. A neurological examination, including electromyography was performed. Results and discussion. According to electromyography, the changes indicated in favor of a lesion in the nerves of the right lumbosacral plexus. A neurological examination of the patient at the time of discharge and 9 months after showed a reduction in neurological symptoms. Four years after the patient’s first admission to the emergency neurology department, weakness and sensory disturbances in the right leg increased again, but no pain syndrome was noted. The patient did not show a clear association between the recovery process at the first exacerbation and medication intake, including methylprednisolone pullet therapy. Therefore, these groups of drugs were not prescribed at the second hospitalization, when spontaneous recovery was observed. Conclusion. At present, the cause of acute and recurrent lumbosacral radiculoplexopathy remains poorly understood; therefore, the treatment strategy in patients without a specified nature of nerve damage depends on the individual response to immunosuppressive and antiviral therapies. The waiting strategy with constant monitoring of neurological symptoms as illustrated by this clinical case allowed us to avoid prescribing ineffective drugs in this case as well as to confirm the theory of spontaneous recovery.