0:00

Now the nerves

0:02

of the lower extremity are all originate from the lumbar

0:05

plexus and the sacral plexus,

0:07

and they are connected through the lumbosacral trunk.

0:11

So I will, uh, discuss a few

0:13

of these terminal, terminal branches.

0:15

The lateral femoral cutaneous nerve, the femoral nerve,

0:19

and the ator nerve, the lumbar plexus

0:23

because of its location, is vulnerable

0:26

to retroperitoneal processes.

0:28

So, uh, surgeries, trauma

0:32

patients taking anticoagulants with retroperitoneal,

0:35

hematomas, abscesses

0:36

and tumor can cause, uh, lumbar plexopathy.

0:40

And this may mimic CAU quinine syndrome.

0:43

The sacral plexus is composed of the lumbosacral chunk

0:47

and the S one two S3 nerve roots.

0:50

And, uh, this afternoon I will discuss the,

0:53

uh, sciatic nerve.

0:55

Uh, the sacral nerve roots will exit the sacral foramen

0:59

and, uh, coalesce anterior to the piriform wrist muscle

1:02

before separating into the terminal branches.

1:07

Uh, the sacral, uh, plexus is vulnerable to pelvic disease.

1:11

So this is an example of a patient who had septic arthritis

1:15

of the SI joint with osteomyelitis

1:17

and you can see some, uh, very low

1:20

to one single involving the sacrum and iliac bone

1:24

and FLAMIN changes anterior to the SI joint.

1:28

But other causes such as, uh, colorectal uh, cancers

1:32

and cervical cancers can also cause sacral plexopathy

1:36

and the patient presents with severe pain,

1:39

proximal muscle weakness, sensory deficits, bowel

1:42

and bladder dysfunction, which can mimic make

1:45

akata aquina syndrome.

1:48

But if we can't find any tumor or abscess

1:52

or uh, a hematoma, we can think of other causes

1:56

that can affect the lumal sacral plexus.

1:59

Uh, for example, diabetic am amnio is a,

2:04

uh, proximal diabetic, uh, neuropathy

2:08

that has a very different clinical course

2:10

and is, uh, much less common than the distal polyneuropathy

2:14

that we commonly see in diabetic patients.

2:17

The patients, uh, present usually with unilateral, um,

2:23

very severe muscle wasting, uh, around the hips,

2:27

the thighs, and the legs.

2:30

Uh, the symptoms usually last a couple of weeks to a couple

2:33

of months and then resolve,

2:36

whereas the distal polyneuropathy is usually bilateral

2:40

and symmetric and either stay stable for several years

2:44

or progresses relentlessly.

2:47

Um, we can think other causes of lumbosacral plexopathy

2:51

or inflammatory neuritis, ghislaine barre

2:54

or CIDP hereditary neuropathy such as charco mary

2:58

Tooth or radiation neuropathy, uh, toxicity

3:03

of chemotherapy agents, rein or vincristine.

3:07

So the, uh, clinical history is very important and,

3:12

and obviously, uh, tumor, tumor

3:14

and, uh, involvement of the lumbosacral plexus

3:18

by neurofibromatosis or lymphoma

3:21

and, uh, also infectious causes.