Lumbosakral Pleksopatiler
Özet
Lumbosakral pleksus, L1-S2 radikslerinden çıkan sinir lifleriyle oluşan, lomber ve sakral olarak ikiye ayrılan derin yerleşimli bir sinir ağıdır. Bu nedenle travmaya bağlı pleksopatiler nadir görülür ve çoğunlukla penetran yaralanmalarla ilişkilidir. Etiyolojide retroperitoneal abseler, hematomlar, arter anevrizmaları, tümörlerin lokal invazyonu veya metastazları ile radyoterapi yer alır. Ayrıca diyabetik ve nöraljik amyotrofi gibi immün aracılı mekanizmalar da önemli nedenlerdendir; diyabetik amyotrofide alt ekstremitede şiddetli ağrı, güçsüzlük ve atrofi belirgindir. Klinik olarak etkilenen bölgeye göre kas güçsüzlüğü ve duysal anormallikler gelişir; lomber tutulumda diz ekstansiyonu, sakral tutulumda ise ayak hareketleri etkilenir. Tanı sürecinde nörolojik muayenenin yanı sıra lezyonun aksonal ya da demiyelinizan yapısını belirleyen elektrodiagnostik testler (EMG ve sinir iletim çalışmaları) kritik rol oynar. Görüntülemede MRG ve BT, pleksusu komprese eden hematom veya abse gibi yapısal nedenleri saptamak için kullanılır. Ayırıcı tanıda ise lumbosakral radikülopati, mononöropatiler, transvers miyelit ile kalça çıkığı veya osteoartrit gibi kemik-eklem problemleri yer alır.
The lumbosacral plexus is a deeply located nerve network formed by nerve fibers originating from the L1-S2 roots, divided into lumbar and sacral plexuses. Therefore, traumatic plexopathies are rare and mostly associated with penetrating injuries. The etiology includes retroperitoneal abscesses, hematomas, arterial aneurysms, local invasion or metastases of tumors, and radiotherapy. Additionally, immune-mediated mechanisms such as diabetic and neuralgic amyotrophy are significant causes; in diabetic amyotrophy, severe pain, weakness, and atrophy in the lower extremity are prominent. Clinically, muscle weakness and sensory abnormalities develop depending on the affected area; knee extension is affected in lumbar involvement, whereas foot movements are impaired in sacral involvement. In the diagnosis process, alongside neurological examination, electrodiagnostic tests (EMG and nerve conduction studies) that determine whether the lesion is axonal or demyelinating play a critical role. In imaging, MRI and CT are utilized to detect structural causes compressing the plexus, such as hematomas or abscesses. The differential diagnosis includes lumbosacral radiculopathy, mononeuropathies, transverse myelitis, and bone-joint problems like hip dislocation or osteoarthritis.
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