Consultant Mayo Clinic Rochester, Minnesota, United States
Case Diagnosis: Bilateral Lumbosacral Polyradiculopathy
Case Description: A 39-year-old previously independent male presented with 2 months of progressive descending sensorimotor deficits resulting in immobility. He is morbidly obese with remote gastric bypass and recent transoral outlet reduction resulting in poor oral intake with intentional 41 kg weight loss over several months. Physical exam showed reduced sensation from mid thoracic level distally, significant lower limb weakness, and absent lower limb reflexes. Vitamin B1 and E levels were low. Whole spine and lumbar plexus MRIs did not show abnormalities to explain his presentation. EMG showed severe multilevel bilateral lumbosacral radiculopathies. Vitamins E and B1 replacement stabilized symptoms. Due to his physical impairments, he was admitted to inpatient rehabilitation. He discharged home after 22 days. He improved to ambulating 200 feet using bilateral solid ankle-foot orthoses and a walker. He was modified independent with self-cares.
Discussions: Lumbosacral polyradiculopathy occurs when there is damage to multiple lumbosacral nerve roots. Mechanical compression is the most common etiology. The attribution of symptoms to multiple nutritional deficiencies after months of poor oral intake is unique. Other causes were less likely given imaging, labs, and clinical course. Proper nutritional supplementation and intensive therapy were critical for his recovery. Functional gains during inpatient rehabilitation led to successful return home with adaptive equipment and outpatient therapies. This patient’s morbid obesity and home layout added additional complexities for safe return home.
Conclusions: This case emphasizes the importance of proper nutritional supplementation follow any procedure altering the GI tract or reducing oral intake as nutritional deficiencies can result in polyradiculopathies with significant functional impairments. If polyradiculopathies do develop, implementing proper nutritional supplementation followed by comprehensive rehabilitation is vital to successful functional improvement. Unique rehabilitation considerations include patient body habitus which can make home environmental barriers and finding proper adaptive equipment more challenging.
