Radikülopati ve Pleksopati Olguları
Özet
Radikülopati ve pleksopati ön tanısıyla incelenen üç farklı olgunun klinik, elektrofizyolojik ve radyolojik bulguları, hastaların ayırıcı tanı süreçlerini şeffaf bir şekilde ortaya koymaktadır. İlk olguda, bel fıtığı operasyonunun ardından düşük ayak şikayetiyle başvuran 63 yaşındaki bir kadında sol L4-L5 radikülopatisine bağlı olarak sol vastus lateralis, tibialis anterior ve peroneus kaslarında nörojenik değişiklikler ve paraspinal kaslarda akut denervasyon bulguları saptanmıştır. İkinci olguda, kolesistektomi sonrasında şiddetli ağrıyı takiben kanat skapula ve omuz hareket kısıtlılığı gelişen 20 yaşındaki bir kadında, sağ lateral antebrakiyal kutanöz sinir ve uzun torasik sinir etkilenmesiyle uyumlu olarak nöraljik amyotrofi tanısı kesinleşmiştir. Üçüncü olguda ise yürüme güçlüğü ve nörojenik kladikasyo tablosuyla başvuran 74 yaşındaki bir kadında, iğne EMG'sinde bilateral L3-L4 paraspinal ve alt ekstremite kaslarında nörojenik tutulum izlenmiş, lomber MRG'deki daralmayla birlikte spinal stenoz teşhisi doğrulanmıştır. İncelemeler, düşük ayak ve kanat skapula gibi karmaşık nörolojik sunumların ayırıcı tanısında klinik muayenenin, detaylı sinir iletim çalışmalarının ve paraspinal iğne EMG değerlendirmelerinin ayırt edici önemini net bir biçimde kanıtlamaktadır.
Clinical, electrophysiological, and radiological findings of three different cases examined with a preliminary diagnosis of radiculopathy and plexopathy clearly demonstrate the differential diagnosis processes of the patients. In the first case, a 63-year-old female presenting with foot drop following disc herniation surgery showed neurogenic changes in the left vastus lateralis, tibialis anterior, and peroneus muscles alongside acute denervation findings in paraspinal muscles due to left L4-L5 radiculopathy. The second case involves a 20-year-old female who developed a winged scapula and shoulder movement limitation following severe pain after cholecystectomy; her diagnosis of neuralgic amyotrophy was confirmed in alignment with the involvement of the right lateral antebrachial cutaneous and long thoracic nerves. In the third case, a 74-year-old female presenting with difficulty walking and neurogenic claudication demonstrated neurogenic involvement in bilateral L3-L4 paraspinal and lower extremity muscles on needle EMG, confirming a spinal stenosis diagnosis alongside narrowing on lumbar MRI. These evaluations explicitly prove the distinct importance of clinical examination, detailed nerve conduction studies, and paraspinal needle EMG assessments in the differential diagnosis of complex neurological presentations like foot drop and winged scapula.
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