Lower Extremity Weakness

In this case study we meet a male patient suffering from a previously inexpllicable right lower extremity weakness.

This patient was referred for evaluation for right lower extremity weakness. The patient has a history of neurofibromatosis with removal of an acoustic neuroma.

On physical examination there is no pain or numbness however this is no right knee extension with gross atrophy of the right anterior thigh musculature. He was referred for further imaging of both the lumbar spinal nerves and femoral nerve.

The lumbar MRI with contrast demonstrates four small nodules in the 3.0 mm to 4.0 mm size range within the cauda equina and descending nerve roots in the thecal sac or lumbar region. It is difficult to specifically associate any one of these with a specific nerve root, such as the L4 root and certainly there is no clear evidence of mechanical pressure, so it is entirely possible that none of these are actually symptomatic.

The MR Neurography study, however, demonstrates a significant mass approximately 4.0 cm in length and 1.0 cm diameter, spindle shaped overall between the psoas and the iliacus muscle within the femoral nerve and very likely the cause of the leg weakness.

Because of the shape it is certainly possible this is a neurofibroma rather than a schwannoma.

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