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Abstract Details

Progressive Non-discogenic L5 and S1 Radiculopathy
Neuromuscular and Clinical Neurophysiology (EMG)
P10 - Poster Session 10 (5:00 PM-6:00 PM)
11-007
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Lumbosacral radiculopathy is often caused by disc herniation or lumbar spondylosis. A 48-year-old man presented with numbness in the left lower extremity and low back pain. He was evaluated by a primary care physician and underwent an electrodiagnostic (EDX) study. This revealed left L5 and S1 radiculopathies with active denervation. An MRI of the lumbar spine without contrast showed mild lumbar spondylosis. Over the following five months, the numbness spread throughout his left leg, accompanied by weakness in the left foot. This significantly impaired his mobility, leading to falls and necessitating the use of a walker. A repeat EDX study showed worsening left L5 and S1 radiculopathies with evidence of motor axonal loss and prominent active denervation. The patient denied any upper extremity symptoms but reported a 40-pound weight loss and night sweats. A repeat MRI of lumbar spine with gadolinium showed enhancement of cauda equina roots. A cerebrospinal fluid testing revealed markedly elevated protein at 264 mg/dL, pleocytosis (21 white blood cells, mostly lymphocytes), and normal glucose levels at 39 mg/dL (serum glucose 86 mg/dL). CSF cytology, and flow cytometry were negative.

A PET scan demonstrated a large hypermetabolic mass in left retroperitoneum, and multiple hypermetabolic lymph nodes liver, scrotum, and osseous sites. A biopsy of the retroperitoneal mass confirmed stage IV diffuse large B cell lymphoma). He was treated with systemic chemotherapy, intrathecal methotrexate, and radiation therapy targeting sacral nerve root and scrotum. Follow-up showed complete resolution of systemic lymphoma, but residual neurological deficits persisted, including right foot drop and left lower extremity weakness.

This case highlights the differential diagnosis of non-discogenic radiculopathy and footdrop and the importance of considering leptomeningeal malignancy in progressive radiculopathy and the utility of gadolinium-enhanced MRI and CSF examination to uncover occult neoplasms.
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Authors/Disclosures
Persen Sukpornchairak, MD (University Hospitals Cleveland Medical Center)
PRESENTER 		Dr. Sukpornchairak has nothing to disclose.
Abdalmalik Bin Khunayfir, MD (Piedmont Healthcare) Dr. Bin Khunayfir has nothing to disclose.
Bashar Katirji, MD, FAAN (University Hospitals Cleveland Medical Ctr- Case Western Reserve University) Dr. Katirji has nothing to disclose.