Lumbosacral plexus syndromes

The proximity of the plexus to important abdominal and pelvic structures renders it liable to damage from diseases of these structures.

Trauma following surgery, e.g. hysterectomy, lumbar sympathectomy or during labour. Compression from an abdominal mass, e.g. aortic aneurysm. Infiltration from pelvic tumour. Radiotherapy.

Symptoms may be unilateral or bilateral, depending upon causation. Weakness, sensory loss and reflex changes are dictated by the location and extent of plexus damage. Pain of a severe burning quality may be present; it may be worsened by coughing, sneezing, etc.

In general:

Weakness of posterior thigh---"

(hamstring) and foot muscles with

posterior leg sensory loss. --

Upper plexus lesions produce: Weakness of hip flexion and adduction with ----- anterior leg sensory loss.

The lumbosacral plexus may be affected in the same way as the brachial plexus in brachial neuritis - lumbosacral neuritis - the association with infection, etc., being similar. Recovery is usually good. Recurrent episodes may occur. Plexus lesions also occur in diabetes mellitus and polyarteritis nodosa. In both, the symptoms and signs may be bilateral. Investigate with CT/MR and neurophysiology.

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