1631 - Lumbar Plexopathy Following Intra-Aortic Balloon Pump

Case Diagnosis: Lumbar Plexopathy

Case Description: 71-year-old male with heart failure secondary to cardiac amyloidosis presented to an inpatient rehabilitation hospital with a primary rehabilitation diagnosis of debility following orthotopic heart transplant. Due to initial cardiogenic shock, patient required an intra-aortic balloon pump (IABP) via right femoral artery for greater than 30 days while awaiting definitive transplant. On exam, his right lower extremity was found to have 2/5 strength in hip flexors, 4/5 strength in knee extensors, and 5/5 strength in hip adductors and abductors, sensory deficits in right lateral femoral cutaneous, anterior femoral cutaneous, and saphenous nerve distributions, and 2+ reflexes at the patella and Achilles bilaterally. Patient denied previous deficits prior to IABP placement.

Discussions: This constellation of symptoms and exam findings localized to the lumbar plexus. Radiculopathy was also considered, but more than one peripheral nerve and spinal root were affected, making this unlikely. Suspected etiology was thought to be inflammatory changes adjacent to the access site versus unnoticed retroperitoneal hematoma. Fortunately, he made excellent functional progress during IPR stay with improved sensory deficits, nearly normal strength in right knee extensors, 4/5 strength in hip flexors, and greater than 200 feet improvement in 6-minute walk test upon discharge. Based on recovery rate, nerve injury classification was most likely neuropraxia with possible axonotmesis. EMG was ordered upon discharge for confirmation of diagnosis and prognostication.

Conclusions: This case describes a patient with lumbar plexopathy following prolonged IABP placement via right femoral artery access. Etiologies of lumbar plexopathies are vast and include traumatic, neoplastic, metabolic, infectious, inflammatory, and radiation-induced causes. This case outlines the importance of identifying similar cases, providing therapies to address neuromuscular deficits, providing bracing or other assistive devices to help patients optimize their maximal functionality following injury, and confirming via electromyography.