Use of MRI in diabetic lumbosacral radiculoplexus neuropathy: case report and review of the literature

Diabetic lumbosacral radiculoplexus neuropathy is often confused with radiculopathy in the context of spinal degenerative disc disease including spinal stenosis. Accuracy in diagnosis may prevent unnecessary interventional procedures including selective nerve root blocks or epidural steroid injections or even surgery in selected cases. Our patient with known diabetes and lumbar disc disease presented with acute onset of pain in L5-S1 distribution of the left lower extremity. Initial MR imaging of the lumbar spine did not show sufficient structural changes to explain her symptomatology. An MR neurogram of the lumbosacral plexus revealed inflammation within the bilateral sciatic and femoral nerves; subsequent EMG demonstrated a generalized sensorimotor neuropathy but no evidence of plexopathy. To our knowledge, this is the first case report that utilized MR imaging of the pelvis to assist in the diagnosis of diabetic lumbosacral radiculoplexus neuropathy (DLRPN).