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Acta Neurochir (Wien) 2018 11 10;160(11):2225-2227. Epub 2018 Sep 10.

Department of Neurosurgery, The George Washington University, 2150 Pennsylvania Avenue, NW, Suite 7-412, Washington, DC, 20037, USA.

Diabetic lumbosacral radiculoplexus neuropathy is often confused with radiculopathy in the context of spinal degenerative disc disease including spinal stenosis. Accuracy in diagnosis may prevent unnecessary interventional procedures including selective nerve root blocks or epidural steroid injections or even surgery in selected cases. Our patient with known diabetes and lumbar disc disease presented with acute onset of pain in L5-S1 distribution of the left lower extremity. Read More

Radiol Case Rep 2017 Dec 25;12(4):815-820. Epub 2017 Jul 25.

Department of Radiology, North District Hospital, Sheung Shui, Hong Kong.

Denervation of muscle usually leads to muscle atrophy with fatty replacement but, uncommonly, also results in muscle hypertrophy or pseudohypertrophy with fatty replacement. We report the ultrasonographic and magnetic resonance imaging (MRI) findings of a patient with diffuse fatty infiltration of calf muscles as a result of denervation pseudohypertrophy. The elevated fasting glucose, neurogenic electromyographic changes, and muscle atrophy with adipose tissue infiltration are consistent with diabetic neuropathy as the cause of denervation pseudohypertrophy. Read More

Cochrane Database Syst Rev 2017 07 26;7:CD006521. Epub 2017 Jul 26.

Division of Neurology, National University Hospital, 1E, Kent Ridge Road, NUHS Tower Block, Level 10, Singapore, Singapore, 119228.

Background: People with diabetes mellitus (DM) sometimes present with acute or subacute, progressive, asymmetrical pain and weakness of the proximal lower limb muscles. The various names for the condition include diabetic amyotrophy, diabetic lumbosacral radiculoplexus neuropathies, diabetic femoral neuropathy or Bruns-Garland syndrome. Some studies suggest that diabetic amyotrophy may be an immune-mediated inflammatory microvasculitis causing ischaemic damage of the nerves. Read More

Case Rep Urol 2015 17;2015:976912. Epub 2015 Dec 17.

Nephrology Department, Shahid Modarres Hospital, Shahid Beheshti Medical University, Saadat Abad, Tehran 1998734383, Iran.

A 34-year-old diabetic patient underwent a renal transplant which was complicated by right side lower extremity paresis and numbness with gluteal necrosis. The main reason was ligation of internal iliac artery of the same side as a result of extensive microvascular obstruction due to severe atheromatous plaque. This is a rare complication which is mostly reported in aneurysmal patients after bypass surgery. Read More

Continuum (Minneap Minn) 2014 Oct;20(5 Peripheral Nervous System Disorders):1343-58

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. Read More

Cochrane Database Syst Rev 2013 Dec 31(12):CD009722. Epub 2013 Dec 31.

Department of Neurology, Radboud University Nijmegen Medical Centre, PO Box 9101, Nijmegen, Netherlands, 6500 HB.

Background: Idiopathic lumbosacral plexopathy (ILSP), also called lumbosacral plexitis or non-diabetic lumbosacral (radiculo)plexus neuropathy is a rare clinical entity. The core features are (sub)acute, severe, asymmetrical leg pain, followed by asymmetrical multifocal weakness and atrophy in the subsequent weeks or months. Sensory symptoms include paresthesias, hypesthesia, allodynia, and autonomic dysfunction. Read More

Handb Clin Neurol 2013 ;115:293-310

Department of Neurology and Clinical Neurophysiology, Radboud University Nijmegen Medical Centre, The Netherlands. Electronic address:

To most doctors, brachial and lumbosacral plexopathies are known as difficult disorders, because of their complicated anatomy and relatively rare occurrence. Both the brachial, lumbar, and sacral plexuses are extensive PNS structures stretching from the neck to axillary region and running in the paraspinal lumbar and pelvic region, containing 100000-200000 axons with 12-15 major terminal branches supplying almost 50 muscles in each limb. The most difficult part in diagnosing a plexopathy is probably that it requires an adequate amount of clinical suspicion combined with a thorough anatomical knowledge of the PNS and a meticulous clinical examination. Read More

Brain 2012 Oct;135(Pt 10):3074-88

Department of Neurology, Hôpital du Sacré-Coeur de Montréal, Montréal, Qc, H4J 1C5, Canada.

Diabetic lumbosacral radiculoplexus neuropathy is a subacute painful, asymmetrical lower limb neuropathy due to ischaemic injury and microvasculitis. The occurrence of a cervical diabetic radiculoplexus neuropathy has been postulated. Our objective was to characterize the clinical features and pathological alterations of diabetic cervical radiculoplexus neuropathy, to see if they are similar to diabetic lumbosacral radiculoplexus neuropathy and due to ischaemic injury and microvasculitis. Read More

Cochrane Database Syst Rev 2012 Jun 13(6):CD006521. Epub 2012 Jun 13.

Division of Neurology, National University Hospital, Singapore, Singapore.

Background: People with diabetes mellitus (DM) sometimes present with acute or subacute, progressive, asymmetrical pain and weakness of the proximal lower limb muscles. The various names for the condition include diabetic amyotrophy or diabetic lumbosacral radiculoplexus neuropathies. Some studies suggest that it may be due to immune-mediated inflammatory microvasculitis causing ischaemic damage of the nerves. Read More

Cochrane Database Syst Rev 2009 Jul 8(3):CD006521. Epub 2009 Jul 8.

Division of Neurology, National University Hospital, 5, Lower Kent Ridge Road, Singapore, Singapore, 119074.

Background: People with diabetes mellitus (DM) sometimes present with acute or subacute, progressive, asymmetrical pain and weakness of the proximal lower limb muscles. The various names for the condition include diabetic amyotrophy, or diabetic lumbosacral radiculoplexus neuropathies. Some studies suggest that it may be due to immune-mediated inflammatory microvasculitis causing ischaemic damage of the nerves. Read More

Neurol India 2008 Oct-Dec;56(4):420-5

Departments of Neurology, Emory University, Atlanta, Georgia and University of Minnesota, Minneapolis, Minnesota 55455, USA.

Background: Lumbosacral radiculoplexus neuropathy (LRPN) originally described in diabetic patients is a distinct clinical condition characterized by debilitating pain, weakness and atrophy most commonly affecting the proximal thigh muscles asymmetrically. The syndrome is usually monophasic and preceded by significant weight loss (at least more than 10 lbs). Though a self-limited condition, recovery is gradual with some residual weakness. Read More

Arch Phys Med Rehabil 2005 Mar;86(3 Suppl 1):S3-10

Section of Physical Medicine and Rehabilitation, Philadelphia Veterans Administration Medical Center and University of Pennylvania, Philadelphia, PA 19104, USA.

Unlabelled: This self-directed learning module highlights mononeuropathies. It is part of the chapter on neuromuscular rehabilitation and electrodiagnosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on diagnostic criteria and classifications of mononeuropathies, including carpal tunnel, brachial neuritis, and lumbosacral plexopathy. Read More

Acta Neurol Scand 2003 Apr;107(4):299-301

Department of Clinical Neurosciences, Room 182A, University of Calgary, 3330 Hospital Drive N.W., Calgary, Alberta, Canada, T2N 4N1.

Three patients are described who had severe and progressive diabetic lumbosacral plexopathy despite active immunosuppressive therapy. One patient developed the condition while immunosuppressed for a cardiac transplant and two others progressed while receiving intravenous gamma globulin. The cases raise questions about current unsupported practices of treatment for this condition. Read More

Curr Treat Options Neurol 2000 Jan;2(1):23-30

Department of Clinical Neurosciences, University of Calgary, Room 182A, 3330 Hospital Drive, N.W., Calgary, Alberta T2N 4N1, Canada.

There are currently no treatments available (beyond optimal control of hyperglycemia) that arrest or reverse progressive diabetic polyneuropathy. Consultation with a diabetologist is indicated for patients with poorly controlled disease and polyneuropathy. Immunotherapy for diabetic lumbosacral plexopathy has been advocated but is not supported to date by class 1 clinical trial evidence. Read More

Semin Neurol 1996 Jun;16(2):173-8

Department of Neurology, Saint Vincents Hospital and Medical Center of New York, New York Medical College, NY 10011, USA.

Diabetic amyotrophy is a disabling illness that is distinct from other forms of diabetic neuropathy. It is characterized by weakness followed by wasting of pelvifemoral muscles, either unilaterally or bilaterally, with associated pain. Sensory impairment is minimal in the cutaneous distribution sharing the same root or peripheral nerve as affected musculature. Read More

J Urol 1990 Jan;143(1):107-9

Renal Transplant Program, Oregon Health Sciences University, Portland.

Renal transplantation is an accepted treatment for patients with end stage renal disease from insulin-dependent diabetes mellitus. Acute lumbosacral plexopathy developed following renal transplantation in 4 female patients with insulin-dependent diabetes mellitus between January 1, 1981 and June 30, 1988. In all 4 patients the internal iliac artery was used for revascularization of the renal allograft with ligation of the anterior and posterior divisions. Read More

Radiographics 1986 May;6(3):401-25

Department of Radiology, University of Michigan Hospitals, Ann Arbor.

Before high resolution computed tomography (CT), the lumbosacral plexus was nearly impossible to image. While individual elements of the plexus are not consistently resolved using CT, the regional anatomy is reproducible and allows accurate evaluation. Normal regional anatomy was established by axial cadaver dissection and review of 233 normal computed tomographic examinations. Read More

Ann Neurol 1984 May;15(5):457-64

Six patients had a syndrome of painful lumbosacral plexopathy and elevated erythrocyte sedimentation rate. Sural nerve biopsy in each case showed axonal degeneration and epineurial arterioles surrounded by mononuclear inflammatory cells. Differential fascicular involvement suggested an ischemic cause in three nerves, but no patient had a necrotizing vasculitis. Read More