Department of Neurology, 6915Mayo Clinic, Rochester, MN, USA.
Department of Radiology, 6915Mayo Clinic, Rochester, MN, USA.
Neuroradiol J. 2023 Feb;36(1):116-118. doi: 10.1177/19714009221109895. Epub 2022 Jun 18.
Peripheral neuropathies are a recognized complication of labor in the post-partum period. Herein, we describe an uncommon presentation of sciatic mononeuropathy due to ischiofemoral impingement during labor. A 29-year-old, gravida 4 para 2, female presented post-partum with acute left lower limb paresthesia and left foot drop, following spontaneous vaginal delivery of twins. Neurological examination demonstrated no activation of the left sciatic-innervated muscles and sensory loss in the same distribution. Electromyography (EMG) demonstrated an acute complete left sciatic mononeuropathy. MRI of the lumbosacral plexus and sciatic nerve showed a narrowed quadratus femoris space with mild edema of the muscle, consistent with ischiofemoral impingement syndrome. In addition, there was flattening of the sciatic nerve as it passed through the ischiofemoral space. She was treated conservatively, and at 7-month follow-up, there was marked improvement in muscle strength with ongoing sensory impairment. Repeat EMG demonstrated reinnervation in all sciatic-innervated muscles. This case highlights the risk of a sciatic mononeuropathy secondary to ischiofemoral impingement in the peripartum setting. Future studies are needed to determine if women with a narrow ischiofemoral space at baseline are at increased risk for peripheral nerve injury during labor.
周围神经病变是产后时期分娩的公认并发症。在此，我们描述了一例因分娩时闭孔上坐骨神经压迫而导致的罕见坐骨神经单神经病。一名 29 岁，经产妇 4 次分娩 2 次，自然阴道分娩双胞胎后出现急性左下肢感觉异常和左足下垂。神经系统检查显示左侧坐骨神经支配的肌肉无活动，同一分布区感觉丧失。肌电图（EMG）显示左侧坐骨神经急性完全单神经病。腰骶丛和坐骨神经 MRI 显示四头肌空间变窄，肌肉轻度水肿，符合闭孔上坐骨神经压迫综合征。此外，坐骨神经在穿过闭孔上坐骨神经间隙时变平。她接受了保守治疗，7 个月随访时，肌肉力量有明显改善，感觉障碍持续存在。重复肌电图显示所有坐骨神经支配的肌肉均有再支配。该病例强调了在围产期，由于闭孔上坐骨神经压迫，坐骨神经单神经病的风险。需要进一步研究以确定基线时坐骨神经空间狭窄的女性在分娩过程中是否有增加周围神经损伤的风险。
