9.6. Immune Mediated/Toxic and Anesthetic Causes of Lumbosacral Plexopathy
- Acute inflammatory demyelinating polyneuropathy (AIDP): may hit proximal plexus
- Chronic inflammatory demyelinating polyneuropathy (CIDP): distal nerve greater than proximal roots
- Specific epitope syndromes:
- GM1
- Gal-NAC-GTd1a
- MAG
- SGPG
- Anti sulfatide
- Paraneoplastic:
- Anti-Hu
- At-Yo
- Anti-MA
- Anti-TA
- Post vaccination
- Post serums (anti-venoms)
Toxins/Anesthetics
- Lidocaine/bupivacaine 0.25% or greater concentration by epidural catheter
- Benzyl alcohol (adjuvant of anesthetics)
- Heroin:
- Delayed symptom (1–2 days)
- Diffuse pain
- Minimal weakness or sensory loss
- Pain clears prior to recovery of motor function
Cause of Gadolinium Enhancement of Lumbosacral Plexus on MRI
- Carcinomatous meningitis
- AIDP
- CIDP
- Arachnoiditis
- CMV
- Sarcoid
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