Medicine · 2019
Severe lumbar radiculopathy with epidural venous plexus engorgement in a morbidly obese pediatric patient: A case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Jeong Hee Joon, Sim Woo Seog, Park Hue Jung, Lee Seung Hwan, Oh Min Seok, Cho Min Kyoung, Seon Heui Jin, Lee Jin Young
Аннотация
INTRODUCTION: Engorgement of the epidural venous plexus (EVP) is a rare cause of nerve root impingement. Dilated epidural veins cause compression of the thecal sac and spinal nerve roots, leading to lumbar radiculopathy.
PATIENT CONCERNS: Here we describe a case of severe lumbar radiculopathy in a 15-year-old morbidly obese boy.
DIAGNOSIS: Enhanced lumbar magnetic resonance imaging revealed left sided L1-L2 disc protrusion and engorgement of the lumbar EVP, resulting in narrowing of the thecal sac in the entire lumbar spine. There was no evidence of an intra-abdominal mass, thrombosis of the inferior vena cava, or vascular malformation.
INTERVENTIONS: A caudal epidural block was administered under fluoroscopic guidance. The patient reported a 30% reduction in pain intensity for just 1 day.
OUTCOMES: The patient has been followed up for 2 years. He continues to take medication, including morphine sulfate 15 mg, gabapentin 300 mg, and oxycodone 20 mg per day. He is on a diet with exercise for weight reduction.
CONCLUSION: An engorged EVP should be considered in the differential diagnosis of radiculopathy in morbidly obese patients.
PATIENT CONCERNS: Here we describe a case of severe lumbar radiculopathy in a 15-year-old morbidly obese boy.
DIAGNOSIS: Enhanced lumbar magnetic resonance imaging revealed left sided L1-L2 disc protrusion and engorgement of the lumbar EVP, resulting in narrowing of the thecal sac in the entire lumbar spine. There was no evidence of an intra-abdominal mass, thrombosis of the inferior vena cava, or vascular malformation.
INTERVENTIONS: A caudal epidural block was administered under fluoroscopic guidance. The patient reported a 30% reduction in pain intensity for just 1 day.
OUTCOMES: The patient has been followed up for 2 years. He continues to take medication, including morphine sulfate 15 mg, gabapentin 300 mg, and oxycodone 20 mg per day. He is on a diet with exercise for weight reduction.
CONCLUSION: An engorged EVP should be considered in the differential diagnosis of radiculopathy in morbidly obese patients.