Ischaemic lumbosacral plexopathy in acute vascular compromise: case report

Anterior spinal artery syndrome (ASAS) is a well reported cause of spinal cord injury (SCI) following thoracoabdominal aortic surgery. The resultant deficits are often incomplete, typically attributed to the variable nature of the vascular distribution. Our Physical Medicine and Rehabilitation (PM and Rehabilitation) service was consulted about a 36-year-old patient with generalised deconditioning, 3 months after a stab wound to the left ventricle. Physical examination revealed marked lower extremity weakness, hypotonia, hyporeflexia, and a functioning bowel and bladder. Further questioning disclosed lower extremity dysesthesias. Nerve conduction studies showed slowed velocities, prolonged distal latencies and decreased amplitudes of all lower extremity nerves. Electromyography revealed denervation of all proximal and distal lower extremity musculature, with normal paraspinalis. Upper extremity studies were normal. Recently, 3 cases of ischaemic lumbosacral plexopathy, mimicking an incomplete SCI, have been reported. This distinction is particularly difficult in the polytrauma patient with multiple musculoskeletal injuries or prolonged recuperation time, in addition to a vascular insult, as in this patient. The involved anatomical considerations will be discussed. A review of the electrodiagnostic data from 30 patients, with lower extremity weakness following acute ischaemia, revealed a 20% incidence of spinal cord compromise, but no evidence of a plexopathy.