Dissecting a radiculomedullary artery as an infrequent cause of low back pain: illustrative case.

BACKGROUND: There is currently no case described in the literature of epidural hematoma associated with subarachnoid hemorrhage due to dissection of a spontaneous radiculomedullary artery at the lumbar level and therefore its incidence and prevalence are not known. However, its etiology is thought to be similar and may not be diagnosed given its nonspecific symptomatology. OBSERVATIONS: The authors present the case of an adult patient who consulted the emergency department for 2 weeks of low back pain. On physical examination there were negative signs of radiculopathy without neurological focalization. The patient was evaluated by neurosurgery via thoracic and lumbosacral spine magnetic resonance imaging, with findings of epidural hematoma associated with subarachnoid hemorrhage in the lumbosacral region. After that, panangiography was done. In the study, it was possible to visualize a dissection of the radicular artery at the L2 level. The patient was not a candidate for surgical management and continued with medical pain management. The patient has a good clinical evolution and was discharged. LESSONS: The aim of the present case is to describe a unique case of radiculomedullary artery dissection as a cause of spontaneous epidural hematoma associated with a subarachnoid hemorrhage in the lumbar region.

Multiple cranial neuropathy: Clinical findings in a case series of 142 patients.

INTRODUCTION: Multiple cranial neuropathies (MCN) is an entity frequently seen in clinical practice but there is a lack of studies published about this entity, with most of them based on case reports and small case series. OBJECTIVE: The aim of this study is to describe the clinical involvement of different cranial nerves, the location within the central or peripheral nervous system and the diagnosis in a group of patients with MCN managed in one hospital in Bogotá-Colombia. METHODOLOGY: A case series study was conducted using the electronic clinical records of a teaching hospital in Bogota-Colombia. Clinical data were collected from patients aged ≥18 with a clinical diagnosis of MCN between 2015 and July 2021. RESULTS: The cranial nerves most commonly affected were III and VII, with the most prevalent combinations being III-IV, III-VI, and V-VII. Among etiologies, the most frequently found were autoimmune, vascular and neoplastic and most common locations included peripheral nerves, neuromuscular junction, cavernous sinus and lateral medulla. CONCLUSIONS: The differential diagnosis of MCN is broad, but clinical clues may aid in identifying the underlying etiology. According to our results, MG was the most frequent etiology, so it should be considered in any patient with a clinical diagnosis of MCN associated with fatigability.