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A difficult case
Ischaemic lumbosacral plexopathy following aortic dissection
  1. Bruna Gutierres Gambirasio1,
  2. Rodrigo Matos Amaral1,
  3. Thiago Yoshinaga Tonholo Silva1,
  4. Danilo Manuel Cerqueira Costa2,
  5. Flavio Moura Rezende Filho1,
  6. Pedro Henrique Reis Caldeira Brant1,
  7. Marcio Luiz Escorcio-Bezerra1,
  8. Orlando G P Barsottini1,
  9. José Luiz Pedroso1
  1. 1 Department of Neurology, Universidade Federal de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
  2. 2 Department of Diagnostic Imaging, Universidade Federal de São Paulo, São Paulo, Brazil
  1. Correspondence to Professor Orlando G P Barsottini, Department of Neurology, Universidade Federal de São Paulo, Sao Paulo, Brazil; orlandobarsottini{at}gmail.com

Abstract

A 57-year-old man was diagnosed with acute myocardial infarction and Stanford type A aortic dissection that had spread to the common iliac arteries. He underwent a Bentall procedure for vascular repair. Immediately after surgery, he developed numbness and severe weakness in his left leg. On examination, he had hypotonia, absent deep tendon reflexes, weakness in the left leg (Medical Research Council (MRC) scale for muscle strength - 0/5 distal, 3/5 proximal) and reduced sensation in the left leg. Electromyography confirmed subacute involvement of the left lumbar and lumbosacral plexus. MR scan of the lumbar plexus showed diffuse muscle oedema involving the left gluteus maximus. We diagnosed ischaemic lumbosacral plexopathy secondary to extensive aorta dissection and internal iliac artery occlusion. We discuss the clinical features of ischaemic plexopathy and the diagnostic approach and review the vascular anatomy of the lumbosacral plexus.

  • peripheral neuropathology
  • vascular surgery
  • anatomy

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/pn-2022-003462

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors BGG, OGPB, JLP: conception of the project: conception, organisation and execution; manuscript: writing of the first draft and review and critique. RMA, DMCC, FMRF, PHRCB, MLE-B: conception of the project: conception, organisation and execution. TYTS: conception of the project: conception, organisation and execution; manuscript: review and critique.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned. Externally peer reviewed by Kathryn Brennan, Glasgow, UK.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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