Magnetic resonance imaging of sciatic nerve compression injury after epidural blockade

Mumby, D.M.; Hartsilver, Emma

doi:10.1016/j.ijoa.2011.12.004

Cited by 7 publications

(9 citation statements)

References 3 publications

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“…Rarer causes of sciatic neuropathy are piriformis syn- drome, primary tumors of sciatic nerve, [4] metastatic tumors invading or compressing the nerve, [4] endometriosis, [5] vascular malformations. [6] Prolonged immobilization, [7] or specific positions especially associated with distinct operations [8,9] since sciatic nerve is thick and less vulnerable to injury. Possible causal factors in our case were intramuscular injection, prolonged immobilization and positioning in the lithotomy position during curettage procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Swelling and edema around the sciatic nerve at the level of the ischial tuberosity were also reported in sciatic compression neuropathy. [8] MRI of intrinsic nerve tumors may resemble with abnormal thickening and enhancement. [4] For that reason, we followed serial findings which supported our first hypothesis of compression neuropathy because increased signal intensity and contrast enhancement resolved even in a short period.…”

Section: Discussionmentioning

confidence: 99%

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Sciatic neuropathy developed after injection during curettage

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et al. 2016

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JANUARY 2016 46 ÖzetKas içi enjeksiyonlar, gelişmekte olan ülkelerde siyatik sinir hasarının en sık nedenidir. Piriformis sendromu, siyatik sinir primer tümörleri, sinire invazyon ya da bası yapan metastatik tümörler, endometriyozis, vasküler malformasyonlar, uzamış immobilizayon veya spesifik pozisyonlar daha nadir siyatik nöropati nedenleridir. En güvenilir tanı yöntemleri sinir ileti incelemeleri ve elektromiyografi olmakla birlikte manyetik rezonans görüntülemenin lezyon tipini belirlemek, lezyon bölge ve seviyesini kesinleştirmekte alternatif inceleme yötemi olduğu ileri sürülmektedir. Burada, sedasyon altında uzun süreli litotomi pozisyonunda kas içi enjeksiyon sonrasında gelişen siyatik nöropati olgusu sunmaktayız.Anahtar Kelimeler: Elektrofizyoloji; manyetik rezonans görüntüleme; siyatik nöropati. SummaryIntramuscular injections are likely the most common cause of sciatic nerve injury in developing countries. Less common causes include piriformis syndrome, primary tumors of the sciatic nerve, metastatic tumors invading or compressing the nerve, endometriosis, vascular malformations, and prolonged immobilization or positioning. While the most reliable diagnostic and prognostic methods include nerve conduction studies and electromyography, magnetic resonance imaging has been suggested as an alternative method of determining type of lesion, establishing location, and investigating level of nerve involvement. A case of sciatic neuropathy that developed after intramuscular injection, with patient in prolonged lithotomy position and under sedation, is described.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Sciatic neuropathy developed after injection during curettage

Altıntaş

Gündüz

Kantarcı

et al. 2016

Agri

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“…Rarer causes of sciatic neuropathy are piriformis syn-Sciatic neuropathy developed after injection during curettage drome, primary tumors of sciatic nerve, [4] metastatic tumors invading or compressing the nerve, [4] endometriosis, [5] vascular malformations. [6] Prolonged immobilization, [7] or specific positions especially associated with distinct operations [8,9] since sciatic nerve is thick and less vulnerable to injury. Possible causal factors in our case were intramuscular injection, prolonged immobilization and positioning in the lithotomy position during curettage procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Swelling and edema around the sciatic nerve at the level of the ischial tuberosity were also reported in sciatic compression neuropathy. [8] MRI of intrinsic nerve tumors may resemble with abnormal thickening and enhancement. [4] For that reason, we followed serial findings which supported our first hypothesis of compression neuropa-thy because increased signal intensity and contrast enhancement resolved even in a short period.…”

Section: Discussionmentioning

confidence: 99%

Sciatic neuropathy developed after injection during curettage

ALTINTAS¹

2015

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JANUARY 2016 46Özet Kas içi enjeksiyonlar, gelişmekte olan ülkelerde siyatik sinir hasarının en sık nedenidir. Piriformis sendromu, siyatik sinir primer tümörleri, sinire invazyon ya da bası yapan metastatik tümörler, endometriyozis, vasküler malformasyonlar, uzamış immobilizayon veya spesifik pozisyonlar daha nadir siyatik nöropati nedenleridir. En güvenilir tanı yöntemleri sinir ileti incelemeleri ve elektromiyografi olmakla birlikte manyetik rezonans görüntülemenin lezyon tipini belirlemek, lezyon bölge ve seviyesini kesinleştirmekte alternatif inceleme yötemi olduğu ileri sürülmektedir. Burada, sedasyon altında uzun süreli litotomi pozisyonunda kas içi enjeksiyon sonrasında gelişen siyatik nöropati olgusu sunmaktayız. Anahtar Kelimeler: Elektrofizyoloji; manyetik rezonans görüntüleme; siyatik nöropati. SummaryIntramuscular injections are likely the most common cause of sciatic nerve injury in developing countries. Less common causes include piriformis syndrome, primary tumors of the sciatic nerve, metastatic tumors invading or compressing the nerve, endometriosis, vascular malformations, and prolonged immobilization or positioning. While the most reliable diagnostic and prognostic methods include nerve conduction studies and electromyography, magnetic resonance imaging has been suggested as an alternative method of determining type of lesion, establishing location, and investigating level of nerve involvement. A case of sciatic neuropathy that developed after intramuscular injection, with patient in prolonged lithotomy position and under sedation, is described.

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“…Time until recovery, if recovery occurs, depends on the degree of nerve lesioning, e.g., neurotmesis or neuroapraxia, and may take months to years [6]. MRN has significant potential to identify plexus injuries and nerve compression [7] and plays a fundamental role in clinically and electrodiagnostically inconclusive cases [8,9].…”

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confidence: 99%

Foot drop after a suicide attempt

2014

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Sciatic neuropathy with denervation and myonecrosisA 33-year-old male presented with a 2-month history of left foot drop, starting upon waking up 3 days after a suicide attempt with ingestion of high doses of phenobarbital, clonazepam, and alcohol. Painful left drop foot, trophic changes in the lower extremities, and bilateral Achilles areflexia were noted. Magnetic resonance neurography (MRN) of the lumbosacral plexus and left thigh showed thickening and signal intensity (SI) abnormality in the left sciatic nerve along the pelvic outlet and proximal thigh (Fig. 1). Denervation of the lumbosacral plexus affecting the quadratus femoris, piriformis, obturator, and adductor muscles with areas without contrast enhancement consistent with myonecrosis was seen on the pelvis, while denervation of the hamstring muscles related to sciatic neuropathy was seen on the thigh (Fig. 2). Electroneuromyography showed complete motor and sensitive axonal impairment of the left peroneal nerve, partial impairment of the left tibial nerve (with reinnervation), and partial impairment of the left femoral nerve.A compressive-ischemic mechanism after a long-term sideways position during unconsciousness was indicated as the cause of the clinical and imaging findings in this case. Sciatic neuropathy is the second most common cause in the legs, after peroneal neuropathy, and may be caused by acute or chronic compression, stretching, ischemia, laceration, or toxic injury (injections) as well as iatrogenic lesions (hip arthroplasty). Increased pressure on the nerve can cause injury either directly or indirectly as a result of compression of the vasa nervorum if the ischemia is prolonged, which was the most likely mechanism in our case [1,2]. The sciatic nerve derives from the fourth and fifth lumbar and first and second sacral roots, coursing down deeper to the piriformis muscle with anatomical variations. It continues posteromedially to the hip and distally deep in the thigh before dividing into the tibial and common peroneal nerves above the popliteal fossa [2,3].MR imaging patterns vary depending on the muscle denervation stage: acute and subacutely denervated muscles show high SI on fluid-sensitive images and normal SI on T1-weighted images; in chronic denervation, muscle atrophy and fatty infiltration demonstrate high SI on T1-weighted images in association with volume loss [4]. On the other hand, myonecrosis is revealed by high SI on T1-weighted images, heterogeneously high SI on T2-weighted images, and rim enhancement on contrastenhanced images [5]. A possible overlap of denervation No related papers from the same study have been published or submitted.The case presentation can be found at

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Magnetic resonance imaging of sciatic nerve compression injury after epidural blockade

Cited by 7 publications

References 3 publications

Sciatic neuropathy developed after injection during curettage

Sciatic neuropathy developed after injection during curettage

Sciatic neuropathy developed after injection during curettage

Foot drop after a suicide attempt

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