Mri Imaging And Clinical Features Of Sciatic Nerve Injection Injury

A young Chinese man was hospitalized in our Department to investigate the cause of his right inferior limb atrophy associated to an abnormal gait with a foot drop (video 1). This condition was prolonged for approximately six years and had led to severe right ankle skeletal deformities.The patient complained of sensory loss in his right leg, and right ankle jerk reflex was absent. The differential diagnosis included infectious diseases associated with chronic peripheral nervous system involvement, atypical motor neuron diseases and major causes of lumbosacral plexopathy such as diabetes, neoplastic involvement of the plexus, expanding hematoma or plexitis. Electrodiagnostic recordings showed absent right superficial peroneal nerve and reduced sural nerve response, absence of right common peroneal nerve compound muscle action potential and evidence for denervation in right tibialis anterior, gluteus maximus and gluteus medius muscles. These features suggested a chronic axonal damage in the posterior division of the sacral plexus [1], including common peroneal division of the sciatic nerve, superior and inferior gluteal nerves (video 1).The patient's medical history was collected with the help of an interpreter, allowing us to discover that few years before the patient had received an injection of an unidentified drug in his right gluteus, and this was followed by right -sided acute severe pain and subsequent thigh and leg weakness with chronic progressive worsening. The medical record excluded any familiar neurological disease; in particular, there was no genetic predisposition for polyneuropathy, such as Charcot Marie Tooth or hereditary neuropathy with liability to pressure palsies.