Sciatic neuropathy

Case contributed by Dr Ali Abougazia

Presentation

This patient had a motor vehicle accident and sustained multiple fractures, one of which is left femoral shaft fracture that required intramedullary nail placement. Directly after the surgery, the patient lost sensation in his left lower limb. This exam was done 6 months later after EMG suggested a sciatic nerve injury.

Patient Data

Age: 30
Gender: Male
MRI

Fracture right upper and lower pubic arches as well as fracture left iliac bone para-SIJ. 

The left sciatic nerve is seen slightly swollen in the left greater sciatic notch just superior to the left ischial spine. Upward displacement of the left hemipelvis and left ischial spine causing indentation of the left sciatic nerve is noted.  No loss of its continuity or related masses are seen.

The scanned skeletal muscles of the left gluteal region and left thigh show decreased girth as well as increased signal in T1 and fluid sensitive sequences. These muscles show evident post-contrast enhancement as well.

Annotated image

The left sciatic nerve shows intense post contrast enhancement. 

Case Discussion

Thickened enhancing left sciatic nerve with no loss of continuity or related masses; however, upward displacement of the left hemipelvis and left ischial spine causes more indentation of the left sciatic nerve; mostly representing post-surgical inflammatory as well as possible entrapment sciatic neuropathy. Atrophic left gluteal and left thigh muscles; mostly combined effect of sciatic nerve injury and disuse atrophy.

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Case information

rID: 21818
Case created: 20th Feb 2013
Last edited: 4th Dec 2015
Inclusion in quiz mode: Included

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