Age / Sex : 63 / F

Chief complaint: Right lower extremity weakness. PHx> IM injection in NSAIDS 10 days ago

What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(Please submit only one answer)

Courtesy: Sheen Woo Lee,  Gachon University

Sciatic nerve injury

Discussion

Findings: Diffuse swelling and T2-hyperintensity, enhancement, right sciatic nerve.

Differential Diagnosis: 1) Sciatic neuropathy , 2) Sciatic nerve injury

Diagnosis: Sciatic nerve injection injury

Discussion:

Overall incidence unknown

Common complication following intramuscular injection, the most frequently affected nerve, especially in children, elderly

Symptoms of sciatic neuropathy depend on the level of injury

Cause: direct needle trauma, secondary compression by scar tissue, by accumulation of the injected drug within the spaces where the sciatic nerve travels

Diagnosis

Clinical examination, magnetic resonance, imaging and electromyography

MR: increased signal intensity on T2-weighted images of injured nerves

Treatment :

Conservative management.

Surgical exploration: complete deficit of the tibial or peroneal distributions without signs of clinical or electromyographical recovery within 3–6 months

References:

J Int Med Res. 2014 Jun 11;42(4):887-897

RadioGraphics 2010; 30:983–1000

Br J Radiol. 2010 Sep;83(993):791-803