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IMAGES IN NEUROLOGY
Year : 2017  |  Volume : 20  |  Issue : 4  |  Page : 416-417
 

A rare presentation of a nondiscogenic cause of acute lumbar radiculopathy


Department of Neurology, Narayana Institute of Neurosciences, Bengaluru, Karnataka, India

Date of Web Publication25-Oct-2017

Correspondence Address:
Lobo Manuel Alexander
Department of Neurology, Narayana Institute of Neurosciences, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aian.AIAN_245_17

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How to cite this article:
Alexander LM, Philip VJ. A rare presentation of a nondiscogenic cause of acute lumbar radiculopathy. Ann Indian Acad Neurol 2017;20:416-7

How to cite this URL:
Alexander LM, Philip VJ. A rare presentation of a nondiscogenic cause of acute lumbar radiculopathy. Ann Indian Acad Neurol [serial online] 2017 [cited 2019 Dec 14];20:416-7. Available from: http://www.annalsofian.org/text.asp?2017/20/4/416/217171




A middle-aged gentleman presented with acute nonradiating continuous lumbalgia after lifting some weights. Examination was unremarkable. He was started on anti-inflammatory drugs and advised rest. Three days later, he returned with worsening pain radiating along left L5 distribution. Left ankle reflex was absent, and straight leg raising test was positive at 30° with no motor deficits. Magnetic resonance imaging lumbosacral spine showed T2 flow voids in the left iliac vessels and left neural foramina, due to an enlarged basivertebral vein causing left L5 root compression [Figure 1] and [Figure 2]. Venous Doppler showed deep venous thrombosis extending from the left common iliac veins to the left popliteal vein.
Figure 1: Axial T2 magnetic resonance imaging images at the level of L5-S1 showing T2 flow void in the inferior part of left neural foramina, due to an enlarged basivertebral vein causing compression to the left exiting L5 nerve root (white arrow head) and absent T2 flow void in the left iliac vessels (black arrow head)

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Figure 2: Sagittal T2 magnetic resonance imaging images T2 cerebrospinal fluid flow void at the level of body of L5 (white star)

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The vertebral venous system is formed by foraminal veins that connect the retrovertebral venous plexus and external venous network and traverse the intervertebral foramen. This is a valveless network that connects to the inferior vena cava, azygos and pelvic veins and is prone to retrograde flow when thoracoabdominal pressure is increased.[1] Spinal epidural variceal compression has been postulated to be secondary to epidural venous plexus expansion due to increased flow into azygos and hemiazygos veins.[2],[3]

This case represents a unique case where deep venous thrombosis presented as a radiculopathy secondary to compression due to an enlarged foraminal vein.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Hanley EN Jr., Howard BH, Brigham CD, Chapman TM, Guilford WB, Coumas JM, et al. Lumbar epidural varix as a cause of radiculopathy. Spine (Phila Pa 1976) 1994;19:2122-6.  Back to cited text no. 1
    
2.
Wong CH, Thng PL, Thoo FL, Low CO. Symptomatic spinal epidural varices presenting with nerve impingement: Report of two cases and review of the literature. Spine (Phila Pa 1976) 2003;28:E347-50.  Back to cited text no. 2
    
3.
Yun SS, Kim JI, Kim KH, Sung GY, Lee DS, Kim JS, et al. Deep venous thrombosis caused by congenital absence of inferior vena cava, combined with hyperhomocysteinemia. Ann Vasc Surg 2004;18:124-9.  Back to cited text no. 3
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