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Neoplastic Lumbosacral Plexopathy Differential Diagnoses

  • Author: Rajesh R Yadav, MD; Chief Editor: Robert H Meier, III, MD  more...
 
Updated: Jul 27, 2015
 
 

Diagnostic Considerations

These include the following:

  • Other causes of lumbosacral radiculopathy
  • Primary plexus tumors
  • Epidural cord compression
  • Chemotherapy toxicity associated with intra-arterial treatment
  • Diabetic amyotrophy
  • Obstetric procedures
  • Intragluteal injections

Meningeal carcinomatosis or leptomeningeal disease also may cause low back or leg pain with subacute motor or sensory involvement; however, patients with these conditions often demonstrate mental status changes, headaches, cranial nerve palsies, and/or nuchal rigidity.

In cancer patients with thrombocytopenia, retroperitoneal bleeding can cause plexopathy accompanied by a rapid onset of pain and neurologic signs that usually are fully developed in 24 hours. Other associated findings include flank, thigh, or low back ecchymoses. A retroperitoneal bleed usually involves the femoral nerve and occasionally will spread to other parts of the plexus.

Other causes of lumbosacral plexopathy to consider are idiopathic in nature, aortic aneurysms, diabetes mellitus, obstetric procedures, trauma, anticoagulation therapy, retroperitoneal hematomas, surgical intervention for mesenteric thrombosis, kidney transplantation, tuberculosis, and intragluteal injections.[8, 9, 10, 11, 12, 13, 14]

Acute pain is common with aortic aneurysm, and the resultant weakness typically worsens over 1-2 weeks and then stabilizes. A pulsatile rectal or abdominal mass frequently is observed.

Acute thigh pain with acute or insidious onset weakness can result from diabetic amyotrophy and can be difficult to differentiate from the pain associated with an aortic aneurysm. In diabetic amyotrophy, weakness is more often noted proximally, with relative sparing of distal lower extremity muscles.

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Rajesh R Yadav, MD Associate Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas Medical School at Houston

Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

Disclosure: Received honoraria from Allergan for speaking and teaching.

Chief Editor

Robert H Meier, III, MD Director, Amputee Services of America; Active Medical Staff, Presbyterian/St Luke’s Hospital, Spalding Rehabilitation Hospital, Select Specialty Hospital; Consulting Staff, Kindred Hospital

Robert H Meier, III, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

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