Meralgia paresthetica following hemorrhoidectomy in the jack-knife position: A case report

Meralgia paresthetica (MP) is a neuropathic pain caused by the entrapment of the lateral femoral cutaneous nerve (LFCN). There have been reports of MP following various surgeries; however, it has not yet been reported after hemorrhoid surgery. We report a case of bilateral MP after hemorrhoid surgery in a jack-knife position. The patient presented with pain, tightness, and a tingling sensation in the anterolateral aspect of both thighs. Ultrasonography-guided LFCN block was used for diagnosis and treatment, along with conservative management for 20 days with oral medication. One month later, the patient's symptoms had resolved completely. MP due to the jack-knife position may occur postoperatively in patients with predisposing risk factors such as obesity and diabetes mellitus, despite adequate padding and a shorter operating time.

Controlled delivery of glial cell line-derived neurotrophic factor enhances motor nerve regeneration / 中国医师杂志

Objective To determine the effect of a motor-specific neurotrophic factor,glial-derived neurotrophic factor (GDNF) on motor nerve regeneration.Methods We used a nerve conduit filled with a fibrin-based delivery system that provided controlled release of GDNF during nerve regeneration.The motor branch of the rat femoral nerve was used to assess motor nerve regeneration across a 5-mm gap.Four experimental groups (n =5) were evaluated.These included GDNF with the fibrin-based delivery system (GDNFDS group),fibrin alone(fibrin group),empty conduit (negative control group),and nerve isograft (positive control group).Nerves were harvested at 5 weeks for analysis by histomorphometry and electron microscopy.Results At 5 mm distal to the conduit or isografts,the GDNF-DS group was not significantly different from the nerve isograft group in the following histomorphometric measures:total nerve fibers,percentage of neural tissue,and nerve density.The number of nerve fibers (respectively:1 744 ± 274,1 481 ± 288)and the percentage of nerve tissue [(14.2 ± 3.9) ％,(11.0 ± 2.2) ％] in theisograft group and the GDNFDS group were significantly higher than that in the fibrin group and the empty conduit group [(respectively:538 ± 93,535 ± 96) and the percentage of nerve tissue respectively:(4.3 ± 1.6) ％,(3.7 ± 0.9) ％].There were no differences in fiber width among all groups.By electron microscopy,the GDNF-DS and isograft groups also demonstrated more organized nerve architecture than the fibrin alone and empty conduit groups.Conclusions The delivery of GDNF from the fibrin-based delivery system promotes motor nerve regeneration at a level similar to an isograft in the femoral motor nerve model.This study gives insight into the potential beneficial role of GDNF in the treatment of motor nerve injuries.

Controlled delivery of glial cell line-derived neurotrophic factor enhances motor nerve regeneration / 中国医师杂志

Objective@#To determine the effect of a motor-specific neurotrophic factor, glial-derived neurotrophic factor (GDNF) on motor nerve regeneration.@*Methods@#We used a nerve conduit filled with a fibrin-based delivery system that provided controlled release of GDNF during nerve regeneration. The motor branch of the rat femoral nerve was used to assess motor nerve regeneration across a 5-mm gap. Four experimental groups (n=5) were evaluated. These included GDNF with the fibrin-based delivery system (GDNF-DS group), fibrin alone(fibrin group), empty conduit (negative control group), and nerve isograft (positive control group). Nerves were harvested at 5 weeks for analysis by histomorphometry and electron microscopy.@*Results@#At 5 mm distal to the conduit or isografts, the GDNF-DS group was not significantly different from the nerve isograft group in the following histomorphometric measures: total nerve fibers, percentage of neural tissue, and nerve density. The number of nerve fibers (respectively: 1 744±274 , 1 481±288) and the percentage of nerve tissue [(14.2±3.9)%, (11.0±2.2)%] in theisograft group and the GDNF-DS group were significantly higher than that in the fibrin group and the empty conduit group [(respectively: 538±93, 535±96) and the percentage of nerve tissue respectively: (4.3±1.6)%, (3.7±0.9)%]. There were no differences in fiber width among all groups. By electron microscopy, the GDNF-DS and isograft groups also demonstrated more organized nerve architecture than the fibrin alone and empty conduit groups.@*Conclusions@#The delivery of GDNF from the fibrin-based delivery system promotes motor nerve regeneration at a level similar to an isograft in the femoral motor nerve model. This study gives insight into the potential beneficial role of GDNF in the treatment of motor nerve injuries.

Femoral Neuropathy Secondary to Autosomal Dominant Polycystic Kidney Disease: A Case Report

Compressive femoral neuropathy is a disabling condition accompanied by difficulty in hip flexion and knee extension. It may result from retroperitoneal hematoma or bleeding, or from complications associated with pelvic, hip surgery, and renal transplants. A 55-year-old female with autosomal dominant polycystic kidney disease presented with proximal muscle weakness in lower extremities. The patient experienced recurrent renal cyst infection, with aggravated weakness during each event. Electromyography and nerve conduction study revealed bilateral femoral neuropathy. Computed tomography and magnetic resonance images were added to further identify the cause. As a result, a diagnosis of femoral neuropathy caused by enlarged polycystic kidney was made. Cyst infection was managed with antibiotics. Renal function was maintained by frequent regular hemodialysis. While avoiding activities that may increase abdominal pressure, rehabilitation exercises were provided. Motor strength in hip flexion and knee extension improved, and was confirmed via electrodiagnostic studies.

Classification and fascicular analysis of variant branching pattern of femoral nerve for microsurgical intervention: a series of thirteen cadavers / Clasificación y análisis fascicular de las variantes en el patrón de ramificación del nervio femoral en intervenciones microquirúrgicas: una serie de 13 cadáveres

Femoral neuropathy associated with lower limb is treated by surgical intervention through activation/regeneration/grafting of nerve fibers by a nerve cuff electrode implant or neuro-prosthesis. These procedures require detailed and precise knowledge of neuro-anatomical variants of the femoral nerve and its fascicular anatomy so that the nerve injury can be investigated and treated more efficiently. The aim of the study is to uncover the variations both in the femoral nerve and its branches, to classify them and to bring out corresponding fascicular anatomy using a hypothesis based on the principle of consistency, continuity and traceability of fascicles. The study was carried out in the Department of Anatomy AIIMS Rishikesh using 13 matched lower limbs (26 femoral nerves) from 13 cadavers. The femoral nerve was exposed in the femoral triangle and traced to the posterior abdominal wall. Variations in the shape, size and course of the femoral nerve and its branches were analyzed. The fascicular arrangement was also conceptualized based on the hypothesis. Seven classes, high division, trunk anomaly, semi-scattered, scattered branching pattern, pectocutaneous, lateral cutaneous nerve of thigh and nerve to sartorius anomalies were detected. The corresponding fascicular organizations were modeled. The seven classes along with corresponding fascicular pattern will be very useful for neurosurgeons, radiologists, anesthetists and anatomists in diagnosis and treatment of femoral neuropathy.

La neuropatía femoral asociada con el miembro inferior es tratada por intervención quirúrgica a través de activación, regeneración e injerto de fibras nerviosas mediante un implante de electrodo de manguito de nervios o neuro-prótesis. Estos procedimientos requieren un conocimiento detallado y preciso de las variantes neuro-anatómicas del nervio femoral y su anatomía fascicular de modo que la lesión del nervio pueda ser investigada y tratada de manera más eficiente. El objetivo del estudio fue descubrir las variaciones tanto en el nervio femoral y sus ramas y clasificarlos a partir de la anatomía fascicular utilizando una hipótesis basada en el principio de la continuidad y trazabilidad de los fascículos correspondientes. El estudio se llevó a cabo en el Departamento de Anatomía AIIMS Rishikesh utilizando 13 miembros inferiores pareados (26 nervios femorales) de 13 cadáveres. El nervio femoral se expuso en el triángulo femoral y fue trazado en la pared abdominal posterior. Se analizaron las variaciones en la forma, tamaño y trayecto del nervio femoral y sus ramas. El patrón fascicular fue conceptulizado de acuerdo a la hipótesis planteada. Se detectaron anomalías clasificadas en: siete clases, división alta, anomalías de tronco, semi-dispersos, patrón de ramificación dispersa, pectocutáneo, nervio cutáneo lateral y nervio del músculo sartorio. Las clasificaciones junto con el patrón fascicular correspondientes serán de gran utilidad para los neurocirujanos, radiólogos, anestesistas y anatomistas en el diagnóstico y tratamiento de la neuropatía femoral.

Meralgia parestésica por compressão de cinta modeladora / Meralgia paresthetica by compression from a modeling girdle

Meralgia parestésica é caracterizada por dor, parestesia ou queimação e diminuição da sensibilidade tátil e dolorosa na face anterolateral da coxa. Isto ocorre por uma neuropatia do nervo cutâneo femoral lateral (NCFL). O tratamento conservador é frequentemente bem-sucedido, aliviando os sintomas na maioria dos pacientes. Descrevemos o caso de uma paciente de 44 anos de idade que apresentou os sintomas descritos após uso pós-operatório de malha modeladora por cirurgia estética.

Meralgia paresthetica is characterized by pain, paresthesia or burning sensation, and reduction of tactile and pain sensitivity in the anterolateral surface of the thigh. This disability is caused by a neuropathy of the lateral femoral cutaneous nerve (LFCN). Conservative treatment is often successful at relieving the symptoms in the majority of patients. We describe the case of a 44-year-old patient who presented with these symptoms caused by postoperative use of a surgical girdle after aesthetic surgery.

Non-operative Treatment of Femoral Neuropathy Caused by Iliacus Hematoma: A Case Report / 대한고관절학회지

Treatment of femoral neuropathy caused by iliacus hematoma can be divided according to operative treatment and non-operative treatment. Recently, percutaneous drainage has been more popular because it is relatively simple, convenient, and less invasive. After warfarin overuse, a 71-year-old male patient visited the emergency room with femoral neuropathy caused by a left iliacus muscle hematoma measuring approximately 110x64 mm, 75x60 mm in size on coronal and sagittal computed tomography angiograhy. Without trauma, weakness of the left hip flexor and left knee extensor was noted with strength of 2/5 (poor) each. Immediate medical treatment using vitamin K and fresh frozen plasma was started and percutaneous drainage was performed. Two days after visiting the emergency room, neurological symptoms were improved and non-operative treatment was continued. Twenty four days after being hospitalized, the size of the hematoma was reduced to approximately 75x45 mm, 62x40 mm in size. Approximately three months after hospitalization, most of the hematoma was absorbed. After one year, mild atrphy of quadriceps and mild diffuse pain were noted, however, no other symptoms were observed.

Femoral Nerve Palsy with Patella Fracture

Femoral neuropathy may be associated with various etiologies and can cause severe walking disability. We present the case of a 25-year-old woman who underwent surgical repair for a patella fracture and complained of lower extremity pain, paresthesia, and weakness postoperatively. Electromyography and magnetic resonance imaging (MRI) revealed partial peripheral neuropathy of the left femoral nerve associated with the patella fracture. To our knowledge, this is the first reported case of femoral neuropathy associated with a patella fracture.

Femoral Neuropathy Secondary to Iliacus Hematoma: A Case Report / 대한고관절학회지

A 17-year-old male patient complained of acutely developed severe paresthesia, pain, and weakness of the right lower extremity. He fell to the ground during performance of hand-stand physical exercise. Despite administration of conservative treatment for two weeks in a private clinic, motor function of the hip flexor and knee extensor were measured as poor grade. EMG showed femoral nerve and lateral femoral cutaneous nerve injury. Findings on MRI and CT revealed a mass measuring 8x5x7 cm in the iliac fossa. After evacuation of the hematoma(400 cc), neurologic dysfunction and thigh circumference were fully recovered, compared with the contralateral side, after one and half year follow up. This condition rarely occurs in individuals without coagulopathy. We reported on a rare case of iliacus hematoma and femoral neuropathy treated by surgical decompression in a patient with no coagulopathy.

Femoral Neuropathy due to Iliacus Muscle Hematoma in a Patient on Warfarin Therapy

Spontaneous hematomas of the iliacus muscle are rare lesions and these are seen in individuals receiving anticoagulation therapy or patients with blood dyscrasias such as hemophilia. It can cause femoral neuropathy and resultant pain and paralysis. Although there is no clear consensus for the treatment of femoral neuropathy from iliacus muscle hematomas, delays in the surgical evacuation of hematoma for decompression of the femoral nerve can lead to a prolonged or permanent disability. We report here on a rare case of a spontaneous iliacus muscle hematoma that caused femoral neuropathy in a patient who was taking warfarin for occlusive vascular disease and we discuss the treatment.

Femoral Neuropathy and Meralgia Paresthetica Secondary to an Iliacus Hematoma

Compressive femoral and lateral femoral cutaneous neuropathies from an iliacus hematoma are unusual presentation. We report a case of a 16-year-old boy who developed right femoral and lateral femoral cutaneous neuropathies as a complication of traumatic ipsilateral iliacus hematoma formation. The patient complained of numbness in the right thigh and calf as well as right leg weakness, and pain in the right inguinal area. Nerve conduction study and needle electromyography identified the neuropathies. After the electrodiagnostic studies, the pelvic bone MRI revealed a large, 9x5x4.5 cm right iliacus hematoma. As a result, diagnosis of a right iliacus hematoma compressing the femoral and lateral femoral cutaneous nerves was made, and the patient underwent an operation to remove the hematoma. Symptoms and neurological signs showed notable improvement after surgical decompression. Subsequent follow-up electrodiagnostic studies after 11 weeks demonstrated regeneration evidence.

Tratamento cirúrgico de dor neuropática em membro inferior por ferimento de arma de fogo: relato de caso / Surgical treatment of lower limb neuropathic pain caused by firearm injury: case report

JUSTIFICATIVA E OBJETIVOS: O tratamento da dor neuropática é difícil e muitos pacientes apresentam alívio parcial e incompleto da dor com o tratamento farmacológico. Em casos de dor neuropática de origem traumática deve ser considerada a possibilidade de tratamento com a exploração cirúrgica, pois existe a possibilidadeda dor ser causada por compressão nervosa devida a fibrose de tecidos adjacentes ou espessamento de bainha. O objetivo deste estudo foi apresentar um caso de sucesso no tratamento cirúrgico de dor neuropática causada por espessamento da bainha no nervo ciático esquerdo causado por ferimento de arma de fogo.RELATO DO CASO: Paciente do sexo masculino, alvejado por tiro de arma de fogo na região glútea esquerda,evoluiu com dor em queimação na região posterior da coxa esquerda, com irradiação para face posterior da coxa, perna e pé, que foi parcialmente controlada por tratamento farmacológico com oxicodona, gabapentina e amitriptilina. Com a persistência das dores, foi feita a exploração cirúrgica no local de entrada do projétil que evidenciou a presença de bulbo em nervo ciático esquerdo e espessamento da bainha, sendo feita endoneurólise para a descompressão de fibrose intraneural. Após acirurgia fez uso de pregabalina, morfina e amitriptilina,e depois de 10 meses da cirurgia estava assintomático,sem uso das medicações. CONCLUSÃO: O tratamento cirúrgico com endoneurólise para a descompressão de fibrose intraneural no nervo ciático esquerdo associado ao tratamento com amitriptilina e pregabalina, controlou com sucesso a dor neuropática causada por ferimento de arma de fogo.

BACKGROUND AND OBJECTIVES: Neuropathic pain is difficult to treat and many patients have partial and incomplete pain relief with pharmacological treatment.When the neuropathic pain has traumatic origin one should consider the possibility of treating with surgical exploration because pain may be caused by nervous compression due to adjacent tissues fibrosis or sheath thickening.This study aimed at presenting a successful case of surgical treatment of neuropathic pain caused by sheaththickening of left sciatic nerve, caused by firearm injury.CASE REPORT: Male patient, reached by firearm shotin the left gluteus region, who evolved with burning pain in the posterior left thigh region, with irradiation to the posterior thigh face, leg and foot, which was partially controlled with pharmacological treatment with oxycodone,gabapentin and amitriptyline. As pain persisted,surgical exploration was performed at the bullet entrysite, which has evidenced the presence of left sciatic nerve bulb and sheath thickening, being performed endoneurolysis for intraneural fibrosis decompression. After surgery, patient was treated with pregabalin, morphine and amitriptyline and 10 months after surgery he was asymptomatic and no longer having medication.CONCLUSION: Surgical treatment with endoneurolysis for intraneural fibrosis decompression in left sciatic nerve associated to treatment with amitriptyline and pregabalin has successfully controlled neuropathic pain caused by firearm injury.

Abdominal Compartment Syndrome Due to Spontaneous Retroperitoneal Hemorrhage in a Patient Undergoing Anticoagulation

Spontaneous retroperitoneal hemorrhage is one of the most serious and often lethal complications of anticoagulation therapy. The clinical symptoms vary from femoral neuropathy to abdominal compartment syndrome or fatal hypovolemic shock. Of these symptoms, abdominal compartment syndrome is the most serious of all, because it leads to anuria, worsening of renal failure, a decrease in cardiac output, respiratory failure, and intestinal ischemia. We report a case of a spontaneous retroperitoneal hemorrhage in a 48-year-old female who had been receiving warfarin and aspirin for her artificial aortic valve. She presented with a sudden onset of lower abdominal pain, dizziness and a palpable abdominal mass after prolonged straining to defecate. Computed tomography demonstrated a huge retroperitoneal hematoma and active bleeding from the right internal iliac artery. After achieving successful bleeding control with transcatheter arterial embolization, surgical decompression of the hematoma was performed for management of the femoral neuropathy and the abdominal compartment syndrome. She recovered without any complications. We suggest that initial hemostasis by transcatheter arterial embolization followed by surgical decompression of hematoma is a safe, effective treatment method for a spontaneous retroperitoneal hemorrhage complicated with intractable pain, femoral neuropathy, or abdominal compartment syndrome.

Bilateral femoral neuropathy after vaginal delivery: A case report / 대한마취과학회지

Epidural analgesia is frequently used for the management of labor pain in parturients. The neurologic complications of epidural analgesia are rare, but they are catastrophic when they occur. We report here on a case of bilateral femoral neuropathy in a vaginal delivery patient with epidural analgesia. The patient complained of weakness of both thighs and numbness around both knees. Neurologic examination and electromyographic study revealed that they occurred due to the delivery itself. The patient had not fully recovered at eight weeks after delivery. The declining incidence of postpartum femoral neuropathy may reflect a reduced duration of labor in accordance with modern obstetric practice, and particularly the more frequent use of Caesarean delivery. The exact etiology of postpartum femoral neuropathy is unknown, and the possible factors are direct compression of nerves that are proximal within the pelvis by either the fetal head or birthing instruments, or this malady is the result of pressure induced ischemia at the level of the inguinal ligament when the pregnant woman is in the lithotomy position.

Neurapraxia do femoral pelo uso do garrote: relato de caso / Femoral neurapraxia due to the use of tourniquet: case report

Os autores descrevem caso de paciente do sexo feminino, com 23 anos de idade, submetida à cirurgia do joelho para realinhamento patelar com uso de garrote pneumático e que desenvolveu neurapraxia femoral. Faz-se breve revisão da literatura sobre as vantagens e desvantagens do uso do garrote em cirurgias do joelho e discute-se a necessidade da sua indicação, considerando-se as complicações acarretadas por seu uso incorreto.

The authors describe the case of a 27 year-old female patient submitted to knee surgery for patellar realignment with the use of a pneumatic tourniquet, who developed femoral neurapraxia. They make a brief literature review about the advantages and disadvantages of using a tourniquet in knee surgeries, and discuss the need for tourniquet indication considering the complications entailed by the incorrect use of the tourniquet.

Femoral Neuropathy caused by Iliopsoas Hematoma: A Case Report / 대한정형외과학회잡지

There are a few reports of femoral neuropathy caused by an iliopsoas hematoma combined with trauma, hemophilia, and anticoagulation therapy. There is some debate as to whether conservative treatment or surgical management is the treatment of choice for femoral neuropathy. In some cases, surgical management is used to minimize the level of nerve damage and for better functional recovery. We report a case of femoral neuropathy on the other side of a total hip replacement arthroplasty (THRA) caused by an iliopsoas hematoma during heparin anticoagulation therapy.

Acute Femoral Neuropathy Secondary to Iliacus Hematoma

A 45-year-old, alcoholic liver cirrhosis patient presented to the Emergency Department(ED) with complaint of acute intense pain and weakness in the right lower extremity without trauma; hip flexor grade 3/5, knee extensor 2/5, and others normal. Initially, emergency physician diagnosed radiculopathy due to high lumbar disc herniation; however, plain a radiograph and an MRI of the lumbar spine did not revealed definitive compression of the nerve root. On the second hospital day at emergency department, swelling, tenderness of anterior proximal thigh and right inguinal pain were detected and computerized tomography (CT) of the abdomen was performed, which revealed diffuse swelling of right iliacus muscle with acute hematoma. Despite extravasation of contrast for CT imaging, the patient was managed conservatively because of improved neurologic deficit and coagulation abnormality of liver cirrhosis. An early correct diagnosis of femoral nerve palsy caused by iliacus hematoma in the ED is unlikely because of its rare incidence and it is difficult for complete history taking during physical examination involving some special case of severe pain such as this case.

A Case of Femoral Compressive Neuropathy in AL Amyloidosis

We describe a case of a 54-yr-old AL amyloidosis patient who developed femoral compressive neuropathy due to iliopsoas pseudohypertrophy. The patient, who presented with end stage renal disease, was referred to our clinic because of lower extremity weakness and polyarthritis. Finally, he was diagnosed as having kappa-AL amyloidosis, complicated by femoral compressive neuropathy, hypertrophic amyloid myopathy, amyloid arthropathy, carpal tunnel syndrome, and end stage renal disease. Femoral compressive neuropathy has never been reported in association with amyloid induced iliopsoas hypertrophic myopathy. This report expands the clinical spectrum of AL amyloidosis.

A Case of Unilateral Femoral Neuropathy Secondary to Recurrent Colon Cancer

No abstract available.

A Case of Primary Iliopsoas Abscess Presented as Femoral Neuropathy in a Hemodialysis Patient / 대한신장학회잡지

Primary iliopsoas abscess is a rare but potentially serious condition. The diagnosis is frequently delayed due to its variable and nonspecific features and occult clinical course. The delayed diagnosis and treatment of iliopsoas abscess is the major poor prognostic factor. We report a rare case of primary iliopsoas abscess that presented as a femoral neuropathy in a patient on hemodialysis. A 49-year-old man with end stage renal disease was admitted due to pain in the left inguinal area, and weakness and hypoesthesia of left lower leg. Left iliopsoas abscess was confirmed by CT and MRI. Left femoral neuropathy was diagnosed with electrodiagnostic study. Iliopsoas abscess with femoral neuropathy was completely treated with CT-guided aspiration, antibiotics and prolonged physical therapy of hip and knee joints. To our knowledge, this is the first case report of primary iliopsoas abscess presented as a femoral neuropathy in a patient on hemodialysis in Korea.