SCI
Francesca Inocentes, MD
Resident Physician
Broward Health
Parkland, Florida, United States
Ariel Inocentes, MD
Attending Physician
Broward Health
Parkland, Florida, United States
Louise F. Inocentes, BA
Ross University School of Medicine
Parkland, Florida, United States
Acute onset bilateral ischemic lumbosacral plexopathy is a rare condition resulting from direct vascular occlusion or hypoperfusion affecting the lumbosacral plexus. This plexus originates from the ventral rami of T12–S4 and innervates the lower back, pelvis, and lower extremities. Ischemia in this region can impair motor function, temperature and pain sensation, and bladder and bowel continence.
Case Description:
73M w/ PMHx of chronic A-fib, R PCA embolic stroke, CAD s/p CABG x4 stents, HFrEF (EF 25–30%) developed paraplegia d/t bilateral ischemic lumbosacral plexopathy after acute aortic occlusion during a prolonged flight from San Francisco to Colombia.
Neuro exam: intact CNII-XII.
MMT: 3/5 UE, 0/5 BLE.
L2 ASIA A: intact light touch and pinprick to L2, absent anal wink and BCR, weak anal tone, 10% perianal and 25% rectal sensation, absent joint position at 1st MTPs.
US Duplex: occluded mid-to-distal aorta and bilateral iliac arteries.
MRI L-spine: edema sacral nerve roots S3, S4.
MRA abdomen: no blood flow in stent in inferior abdominal aorta from level below origin renal artery to level common iliac artery just before bifurcation.
Discussions:
The lumbosacral plexus has a rich blood supply that should minimize the risk of ischemia: 5 lumbar arteries that branch off the abdominal aorta, the deep circumflex iliac artery that branches off the external iliac artery, and the iliolumbar and gluteal branches that derive from the internal iliac artery. That was not the case in our patient who suffered paraplegia 2/2 bilateral ischemic lumbosacral plexopathy after acute aortic occlusion during a prolonged flight. MRA abdomen confirmed absent blood flow through the aortic stent from just below the renal arteries to the common iliac bifurcation.
Conclusions:
Acute onset of bilateral ischemic lumbosacral plexopathy remains a misdiagnosed condition. Increased awareness and further investigation are necessary to improve diagnosis and management.
