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[Lumbar radiculopathy presenting neuralgic amyotrophy with gadolinium-enhanced MRI lesions: a case report].
[neuralgic amyotrophy]
A
40
-
year
-old
man
presented
with
sudden
onset
of
severe
left
buttock
pain
that
radiated
down
the
thigh
to
the
leg
.
On
examination
,
he
showed
moderate
weakness
and
atrophy
in
the
left
quadriceps
and
tibialis
anterior
muscles
,
and
absence
of
a
left
patellar
tendon
reflex
.
Needle
electromyography
revealed
an
active
denervation
pattern
in
the
left
quadriceps
muscles
,
suggesting
neuralgic
amyotrophy
.
Contrast-enhanced
MRI
showed
abnormal
enhancement
of
the
left
cauda
equina
.
Steroid
pulse
therapy
relieved
pain
,
and
subsequent
high
-dose
intravenous
immunoglobulin
prevented
progression
of
muscle
atrophy
and
weakness
.
Neuralgic
amyotrophy
is
characterized
by
attacks
of
severe
neuropathic
pain
and
subsequent
patchy
paresis
in
the
upper
or
lower
extremities
.
Since
overall
recovery
is
less
favourable
than
usually
assumed
,
early
diagnosis
is
very
important
.
This
case
was
remarkable
in
that
contrast-enhanced
MRI
revealed
abnormal
enhancement
and
thickening
of
the
cauda
equina
,
which
may
help
in
achieving
early
diagnosis
and
treatment
.