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The numerous causes of lumbosacral plexopathies are listed in Table 22 6 Diabetic radiculoplexus neuropathy is a fairly common cause of painful leg weakness It has been historically referred to by a considerable number of names, including diabetic amyotrophy, diabetic femoral neuropathy, and the Bruns Garland syndrome99 102 Although there may be considerable variation in the phenotype, almost all individuals who are affected experience severe hip and/or thigh pain as their initial symptom, followed within days by awareness of unilateral leg weakness Adjectives such as aching, stabbing, lancinating, and burning have all been used The exact onset of weakness may be obscured by the severity of pain It typically is recognized and evolves over days to weeks and becomes bilateral in a substantial proportion of individuals who are affected within a matter of months This weakness dominates in the distribution of the lumbar plexus affecting hip exion, adduction, and particularly knee extension The latter can be exceedingly debilitating, and the need for durable equipment to prevent falls is quite prevalent Two-thirds of individuals will have weakness in the L5 myotome and half in the S1 dermatome in addition to the muscles innervated by the L2 4 roots103 Rarely, L5 and S1 myotomal weakness may occur without concomitant involvement of proximal myotomes The reference to diabetic monoradiculopathies earlier in this chapter probably represents a limited expression of this disorder Paresthesias and sensory loss may occur but are typically overshadowed by the pain and weakness A small percentage will have a concurrent or chronologically proximate trunkal neuropathy, which is a helpful clue in support of a diabetic etiology Weight loss, so-called diabetic cachexia, is a common comorbidity Approximately a half of individuals who are af icted will have signs and symptoms attributable to dysautonomia if sought after, including orthostatic intolerance, urinary dysfunction, constipation and diarrhea,.

Plexopathies are typically recognized when motor, sensory, and, if applicable, re ex de cits occur in multiple nerve and segmental distributions con ned to one extremity This is particularly true if de cits can be localized to a single plexus segment, although discrete plexus lesions are not particularly common and are more dif cult to sort out in the lumbosacral plexus than in its brachial counterpart If localization within the lumbosacral plexus can be accomplished, designation as a lumbar plexopathy, a sacral plexopathy, a lumbosacral trunk lesion, or a pan-plexopathy is the best localization that can be expected Although lumbar plexopathies may be bilateral, usually occurring in a stepwise and chronologically dissociated manner, sacral plexopathies are more likely to behave in this manner due to their closer anatomic proximity The differential diagnosis of plexopathy includes disorders of the conus medullaris and cauda equina (polyradiculopathy) If there is a paucity of pain and sensory involvement, motor neuron disease needs to be considered as well In general, intraspinal causes of lower extremity neuropathy are more likely to be bilateral than causes of lumbosacral plexopathy Exceptions are frequent enough, however, to diminish the value of this rule in the evaluation of the individual patient When the differential diagnosis of plexopathy includes a direct neoplastic effect vs the adverse effects of radiation, pain as an initial symptom and unilaterality favor a direct neoplastic effect whereas an insidious onset of painless weakness suggest radiation injury79

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Fixed storage is visible to the operating system as the C: drive and is available for persistently storing user settings, data, and applications This is generally implemented using NAND flash memory, although this is not the only possibility The size of this storage can vary widely among manufacturers Some devices will have additional internal storage made available to the system using another unique drive letter

and out This is vital to any troubleshooting scenario, and it won t happen automatically it takes some practice and discovery on the technician s part You need to be uent in navigating the PC from a user s perspective If there s anything magical about Windows, it s that there s almost always more than one way to get a desired result, and your preferred way might not be the same as your client s As a good customer-oriented tech, you need to be exible in your thinking, and this only comes through practice and more practice As you study and work through these labs, always look for more than one way to access the les or programs you need Many of the shortcuts and hot keys you ll discover can be invaluable aids for a busy tech!

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