Internal Iliac Artery Pseudoaneurysm: An Unusual Cause of Sciatica and Lumbosacral Plexopathy

Various Neurological Symptoms Associated with Infected Internal Iliac Artery Aneurysm: A Case Report

A 68-year-old man presented with a chief complaint of left leg pain; he was later diagnosed with an infected left internal iliac artery aneurysm. Multiple mononeuropathy was suspected. Since the aneurysm had a high risk of rupture, emergency Y-graft replacement was performed. Bacteroides vulgatus was then detected from the pus of the aneurysm. With continuous oral antimicrobial agents following intravenous antimicrobial agents, the patient was noted to have no recurrence. However, his leg pain symptoms continued postoperatively; thus, a supporting device was needed. It should be noted that even neurological symptoms may indicate the presence of aortoiliac aneurysms.

Internal iliac artery pseudoaneurysm: a rare presentation with foot drop and sciatica

Internal iliac artery pseudoaneurysm is rare in incidence with most of them being asymptomatic. It may present with neurologic symptoms like paraesthesia, sciatica, weakness of lower limb, foot drop, etc., and in such scenario, high index of suspicion is needed to diagnose. Early intervention should be the strategy in all symptomatic and in asymptomatic cases with size > 4 cm diameter. We present a case of a 40-year-old female with left internal iliac artery pseudoaneurysm who presented with foot drop and sciatica, which is a very rare presentation, and was managed successfully by resection and interposition grafting.

Lumbosacral Plexopathy Caused by Presacral Recurrence of Colon Cancer Mimicking Degenerative Spinal Disease: A Case Report

Radiculopathy triggered by degenerative spinal disease is the most common cause of spinal surgery, and the number of affected elderly patients is increasing. Radiating pain that is extraspinal in origin may distract from the surgical decision on how to treat a neurological presentation in the lower extremities. A 54-year-old man with sciatica visited our outpatient clinic. He had undergone laminectomy and discectomy to treat spinal stenosis at another hospital, but his pain remained. Finally, he was diagnosed with a plexopathy caused by late recurrence of colorectal cancer, which compressed the lumbar plexus in the presacral area. This case report illustrates the potential for misdiagnosis of extraspinal plexopathy and the value of obtaining an accurate history. Although the symptoms are similar, spinal surgeons should consider both spinal and extraspinal origins of sciatica.

Lumbosacral plexopathy

PURPOSE OF REVIEW

This article provides an up-to-date review of the clinical features and pathogenesis of different types of lumbosacral plexopathy and a clinical approach to their evaluation and management. Often, the pathologic involvement is not limited to the plexus and also involves the root and nerve levels. These conditions are called lumbosacral radiculoplexus neuropathies.

RECENT FINDINGS

The pathophysiology of diabetic and nondiabetic lumbosacral radiculoplexus neuropathy has been elucidated; it is ischemic injury due to a perivascular inflammatory process and microvasculitis. The clinical and neurophysiologic features of these two entities have been found to be similar, consisting of acute or subacute onset of pain and paresthesia followed by profound motor weakness asymmetrically involving the lower limbs and associated with weight loss. A lower limb and motor predominant neuropathy without pain also occurs in diabetes mellitus and has been shown to be a form of diabetic lumbosacral radiculoplexus neuropathy and not diabetic chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The pathophysiology of some cases of postsurgical lumbosacral plexopathies has recently been shown also to be inflammatory from microvasculitis, and treatment with immunotherapy in a timely fashion may be desirable.

SUMMARY

Many pathophysiologic processes, such as neoplastic, traumatic, infectious, radiation, and inflammatory/microvasculitic processes, can affect the lumbosacral plexus causing lumbosacral plexopathy. The clinical symptoms and signs depend on the part of the plexus involved and the temporal course. Management depends on the cause of the lumbosacral plexopathy. Many cases of lumbosacral plexopathy previously thought to be idiopathic have been shown to be caused by ischemic injury from microvasculitis; despite lack of evidence for efficacy in improving neurologic deficits, the authors of this article include immunotherapy in their management of patients with this condition.