Leg Weakness in a Patient with Lumbar Stenosis and Adrenal Insufficiency

Abstract

Preoperative evaluation and operationA 66-year-old male presented with rapidly progressing leg weakness and voiding difficulty, which had developed one month ago. He complained of chronic lower back pain and radiating pain in both legs, which had developed one year previously. Medical history revealed 10 years of treatment for hypertension and diabetes mellitus (DM). On physical examination, the patient appeared very tired and had moderate bilateral calf muscle atrophy. Neurological examination showed a leg motor power of grade IV/III+(right/left), with knee flexion and ankle dorsi-/ plantar-flexion power of grade IV/III. Both knee and ankle reflexes were diminished without no long-tract signs. The patient' s serum sodium level was 131 mEq/L (normal range : 135-146 mEq/L) and other laboratory findings were normal.Magnetic resonance imaging (MRI) showed severe LSS at L4-5 (Fig. 1). Electromyography (EMG) and nerve conduction INTRODUCTIONLumbar spinal stenosis (LSS), first described by Verbiest in 1954 13) , is widely diagnosed disease entity. Katz et al. 8) reported that the more than 30,000 surgical procedures were performed in United States in 1994 to treat LSS. The rate of diagnosis is growing rapidly because of improvements in diagnostic imaging tools and surgical techniques, and the aging of the population 4) . The cardinal symptom of LSS is neurogenic claudication, defined as pain in the buttocks and legs, and numbness or cramping of one or both legs induced by walking, which is relieved when sitting and bending forward 11) . However, not all patients present with typical symptoms and clinical symptoms in elderly patients are often confused with symptoms of peripheral neuropathy, musculo-skeletal disease and other medical conditions 4) . The decision to employ surgery must be made with caution in elderly patients with rapidly progressing leg weakness, because this condition rarely occurs in the absence of other combined conditions, and the incidence of combined disease in the elderly patients is high 6,11) . We report a case of rapid progressive leg weakness in a patient with the LSS and iatrogenic adrenal insufficiency (AI). J Korean Neurosurg Soc 49 : 234-236, 2011 10.3340/jkns.2011 Copyright © 2011 The Korean Neurosurgical Society Lumbar spinal stenosis (LSS) is a common spinal disease in the elderly. The cardinal symptom of LSS is neurogenic claudication, but not all patients present with such typical symptom. The clinical symptoms are often confused with symptoms of peripheral neuropathy, musculo-skeletal disease and other medical conditions in elderly patients. In particular, LSS presenting with rapid progression of leg weakness must be distinguished from other combined diseases. We report a case of rapid progressive leg weakness in a patient with LSS and iatrogenic adrenal insufficiency that was induced by obscure health supplement.