Advertisement

Spontaneous infarction of lumbar roots, vertebrae and paravertebral muscles

Published:January 27, 2021DOI:https://doi.org/10.1016/j.ajem.2021.01.061

      Abstract

      Ischemic injury to the lumbosacral nerve roots and plexus is a rare condition resulting from thrombosis of one or several lumbar arteries.
      As the arterial supply of the spine presents great variations between subjects, the clinical presentation of lumbar thrombosis is highly variable depending on the relative involvement of nerve roots, bones or muscles.
      Diagnosis can be challenging, especially in the acute phase, as different structures can be simultaneously involved. The identification of an enlarged vessel centered in the area of tissue damage can help with the final diagnosis.
      We present the case of a 59-year-old woman who presented with spontaneous incomplete cauda equina syndrome due to diffuse lumbar nerve root infarction. On imaging, acute lumbar artery thrombosis was confirmed, and in addition to nerve roots, adjacent vertebral and paraspinal muscle infarctions were also present.

      Keywords

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gloviczki P.
        • Cross S.A.
        • Stanson A.W.
        • et al.
        Ischemic injury to the spinal cord or lumbosacral plexus after aorto-iliac reconstruction.
        Am J Surg. 1991 Aug; 162: 131-136
        • Long B.
        • Koyfman A.
        • Gottlieb M.
        Evaluation and management of cauda equina syndrome in the emergency department.
        Am J Emerg Med. 2020; 38: 143-148
        • Cifu D.X.
        • Irani K.D.
        Ischaemic lumbosacral plexopathy in acute vascular compromise: case report.
        Paraplegia. 1991; 29 (Jan): 70-75
        • Börnke C.
        • Schmid G.
        • Szymanski S.
        • Schöls L.
        Vertebral body infarction indicating midthoracic spinal stroke.
        Spinal Cord. 2002 May; 40: 244-247
        • Diehn F.E.
        • Hunt C.H.
        • Lehman V.T.
        • et al.
        Vertebral body infarct and ventral Cauda Equina enhancement: two confirmatory findings of acute spinal cord infarct.
        J Neuroimaging. 2015; 25: 133-135
        • Yuh W.T.
        • Marsh E.E.
        • Wang A.K.
        • et al.
        MR imaging of spinal cord and vertebral body infarction.
        AJNR Am J Neuroradiol. 1992 Feb; 13: 145-154
        • Konno T.
        • Suwabe T.
        • Kasahara S.
        • Umeda Y.
        • Oyake M.
        • Fujita N.
        A case of conus medullaris infarction expanding to the vertebral bodies, major psoas and erector spinae muscles.
        Rinsho Shinkeigaku. 2015; 55: 661-664
        • Kobayashi M.
        Spinal cord, vertebral body, paraspinal muscle, and rib infarction: Tiny thrombus detected by CT.
        Neurology. 2016; 87 (09): 642-643