Radiation-Induced Lumbosacral Plexopathy Differential Diagnoses

  • Author: Rajesh R Yadav, MD; Chief Editor: Robert H Meier, III, MD  more...
Updated: Aug 02, 2015

Diagnostic Considerations

Meningeal carcinomatosis, also known as leptomeningeal disease, may cause subacute motor or sensory deficits to be present with low back or leg pain. In addition, patients with meningeal carcinomatosis often also have mental status changes, headaches, cranial nerve palsies, and/or nuchal rigidity. In cancer patients with thrombocytopenia, retroperitoneal bleeding can cause plexopathy, with a rapid onset of pain and neurologic signs that usually are developed fully in 24 hours. Other associated findings include flank, thigh, or low back ecchymoses. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), which is felt to be immune mediated, can cause severe, symmetrical, peripheral neurologic deficits. Nerve root thickening may be noted in the lumbosacral plexus, a finding that may be associated with moderate gadolinium enhancement.[8, 9]

Causes of lumbosacral plexopathy not related to cancer include aortic aneurysms, diabetes mellitus (DM), obstetric procedures, trauma, and intragluteal injections.[10, 11] With aortic aneurysms, acute pain commonly is seen, and the resultant weakness typically worsens over 1-2 weeks and then stabilizes. A pulsatile rectal or abdominal mass also can be seen in many patients. Acute thigh pain with acute or insidious onset of weakness can result from diabetic amyotrophy and can be difficult to differentiate from the aortic aneurysms. Weakness with diabetic amyotrophy usually is noted proximally, with relative sparing of distal lower extremity muscles.

Differential Diagnoses

Contributor Information and Disclosures

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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