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Case 310.

Luisa Chiapparini¹, Valentina Opancina¹, Alessandra Erbetta¹

¹From the Neuroradiology Unit, Department of Technology and Diagnosis (L.C., A.E.), Diagnostic Radiology and Interventional Neuroradiology Unit, Department of Neurosurgery (V.O., E.C.), Neuropathology Unit, Department of Technology and Diagnosis (B.P.), and Department of Neurosurgery (M.B.), Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milan, Italy; and Faculty of Medical Sciences, Department of Radiology, University of Kragujevac, Kragujevac, Serbia (V.O.).

|September 26, 2022

Summary

This summary is machine-generated.

A 49-year-old man experienced sudden onset of right foot drop and leg pain. Diagnostic tests revealed nerve damage, suggesting a possible neurological condition affecting the lumbar and sacral nerve roots.

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Area of Science:

Neurology
Orthopedics
Radiology

Background:

A 49-year-old male presented with acute onset of neurological deficits including right foot drop, bilateral leg pain (cruralgia), and sensory loss in the genital and perianal areas.
The patient had a recent fall resulting in a left fibular fracture, treated surgically.

Observation:

Neurological examination revealed paresthesias, hypoesthesia in the L5 dermatome on the right, and right foot drop.
Laboratory tests showed elevated inflammatory markers (C-reactive protein, erythrocyte sedimentation rate) and liver enzymes (AST, ALT).
Electroneurography (ENG) and electromyography (EMG) indicated severe reduction in nerve signal conduction and muscle activity in the L4, L5, and S1 nerve root territories, with less involvement of L3 bilaterally.

Findings:

Imaging studies, including unenhanced CT and contrast-enhanced MRI of the lumbosacral spine, were performed to investigate the cause of the neurological symptoms.
The findings from ENG and EMG suggest significant compromise of the nerve roots supplying the affected areas.

Implications:

The case highlights the importance of comprehensive neurological and radiological evaluation in patients presenting with acute onset of lower limb and perineal neurological deficits.
Further investigation is warranted to determine the underlying etiology, which could range from inflammatory conditions to structural lesions affecting the lumbosacral spine.