We report the case of a 69-year-old woman, married and housewife, without known drug allergies.
78 kg weight, 1.58 m height and BMI 31.32 kg/m2.
Her personal history included type II diabetes with neuropathy, dyslipidemia, hypertension, OSA, cardiomyopathy and depression.
She had undergone thyroidectomy for thyroid carcinoma 15 years ago, hysterectomy with double adnexectomy 7 years ago, and uterine cure 20 months ago.
At the time of consultation, the patient was under medical treatment with levothyroxine 125 mg, fenobifrate 145 mg, bisoprolol 2.5 mg, lasartan 50 mg, furosemide 20 mg, and glimestones.
He came to our pain unit referred by his primary care physician for progressive bilateral pain in the lower extremities of more than one year of evolution, exacerbated in the last 4 months, with bilateral and claudic radiculopathy.
She was treated with analgesics and adjuvants, which caused mild pain.
Pain radiates through the right posterior face, continuous and shin without circadian variations.
The visual analogue scale (VAS) is 8 in the consultation, reaching a maximum of 9 intensity in the last month.
It is more irritable and has insomnia for several weeks as a result of pain.
On examination the patient adopts an analgesic posture.
It has limited mobility and trunk flexion, with possible muscle damage in lower limbs.
Pain increases with clinostatic position and physical activity.
The pain does not increase with cough, does not refer dysmenorrhea or fever.
Rectal touch does not increase pain.
There is no loss of sphincter control.
The clinical presentation is compatible with L1 radiculopathy because it manifests pain and sensitivity disorders in the inguinal region and eventually paresis of the internal and transverse oblique muscle of the abdomen, and with ileoductor thigh radiculopathy, considering disorders
Lumbar spine showed apophysis at L2-L3 level, with negative fist-percussion.
She has facet pain at lumbar level.
Pain is localized and of increasing intensity.
Possible differential diagnoses include:
1.
Location of the spinal canal.
- Diabetic neuropathy.
Gotrosis - knee
- Radiculopathy due to lumbar discal herniation
- medullary tumor and/or metastasis.
- Myofascial syndrome
- Bilateral sacroiliitis.
1.
Lumbar spondyloarthrosis.
After evaluation, a preferential lumbar MRI was requested, because at present there are no symptoms of horsetail syndrome.
The MRI results showed an extramedullary intradural tumor L1-L2 in the right lateral wall.
Extramedullary intradural meningioma L1-L2 was diagnosed.
1.
Diagnosis is established with analgesic treatment with oxycodone /naloxona 40 mg every 12 hours and recate patterns of rapid-release oxycodone 10 mg every 6 hours.
Pregabalin 75 mg every 12 hours and duloxetine 60 mg every 24 hours are used as adjuvant treatment.
Monthly reviews were performed until lumbar MRI and identification of meningioma and subsequent referral for surgical treatment. A midline lumbotomy and L1-L2 laminectomy were performed with total extramedullary excision of the lesion.
The definitive histological study of the sample was meningothelial meningioma, WHO grade I.
One month after surgery, the patient was reviewed in our unit to see the evolution of the patient following the control of the analgesic treatment.
