Ampute bir hastada lumbosakral kök avulziyonu: Elektrodiagnostik güçlükler

Lumbosakral pleksus lezyonları ve kök avulziyonları nadir olarak görülür ve sıklıkla neden major travmalardır. Elektrofizyolojik incelemeler ve manyetik rezonans görüntüleme tanıda yardımcı olan yöntemlerdir. Normalde elektrofizyolojik değerlendirmeler kolaylıkla yapılabilirken, amputasyonlu bireylerde zorluklar yaşanabilir. Bu yazıda trafik kazası sonrası multipl kırıklar, infeksiyon ve buna bağlı olarak diz altı amputasyonu yapılan 24 yaşında bir erkek hastada lumbosakral pleksus açısından yapılan radyolojik değerlendirme ve karşılaşılan elektrodiagnostik güçlükler tartışılmaktadır. Elektromiyografik değerlendirmede L2-L4 miyotomlarında komplet, L1, L5 ve S1 miyotomlarında ise inkomplet denervasyon bulguları gözlenmiştir. Bunun dışında, paraspinal kasların elektromiyografisi (EMG) normal bulunan hastada, diz altı amputasyonu nedeniyle duyusal sinir iletim çalışmaları ile yeterli bilgi elde edilememiştir. Manyetik rezonans görüntüleme ile L3-5 düzeylerinde kök avulziyonu lehine olan psödomeningosel gözlenmiştir. Her ne kadar, lumbosakral pleksus lezyonlarında sinir iletim çalışmaları ve EMG ile genellikle yeterli tanısal bilgi elde edilse de, özellikle ilgili ekstremitenin amputasyonu nedeniyle elektrofizyolojik incelemelerde kısıtlılıklar olabilir. Bu durumda manyetik rezonans görüntüleme tanıya katkı sunabilir.

Lumbosacral root avulsion in an amputee patient: Electrodiagnostic challenges

Lumbosacral plexus injuries and root avulsions are rare and major traumas are the most common causes. Electrophysiological studies and magnetic resonance imaging (MRI) are helpful in diagnosis. Although electrodiagnostic study is easily done in normal conditions, there may be difficulties in amputee patients. In this report, radiological findings and electrodiagnostic challenges in a 24 year old male patient with multiple fractures and below-knee amputation associated with post-operative infection are discussed in terms of accompanying lumbosacral plexus injury. Electromyographic examination showed complete denervation in L2-4 but incomplete denervation in L1, L5 and S1 myotomes. However paraspinal electromyography (EMG) was normal and sensory conduction studies could not be performed optimally due to the amputation of the extremity below the level of knee. MRI showed pseudomeningocele which suggested avulsion of L3-L5 roots. Although nerve conduction studies and EMG provide sufficient diagnostic information on suspected lumbosacral lesions, there may be difficulties in performing electrophysiological investigations especially in amputee patients. MRI may be helpful in differential diagnosis of these conditions.

Kaynakça

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