Hypertrophic neuropathy of the cauda equina

A 72-year-old woman with a history of lower extremity weakness, pain, and sensory loss in the right thigh for the last 15 months had deteriorated during a period of 6 months. Magnetic resonance imaging of the lumbosacral spine revealed apparent nerve root thickening from L1 to S and spinal canal stenosis. An L1–L3 decompressive laminectomy and durotomy revealed multiple segmentally enlarged and congestive nerve roots. A 1-mm segment of nerve root was resected and submitted for pathological analysis. The pathological examination revealed hypertrophic neuropathy, with nonspecific inflammation. After steroid use, the patient’s symptoms improved. HNCE is a rare disorder that can cause pain and lower extremity weakness, sensory loss, and hyporeflexia. One possible cause is chronic inflammatory demyelinating polyneuropathy (CIDP), but the intrathecal nerve roots are enlarged only patchily and canal stenosis is also present, so the diagnosis is unclear. As this case demonstrates, surgical management and administration of steroids are an effective treatment for some HNCE.