AYŞE ALTINTAŞ, Ayşegül GÜNDÜZ, Fatih KANTARCI, Gökçen ÇELİK GÖZÜBATIK, Naci KOÇER, Meral E. KIZILTAN

Küretaj sırasında enjeksiyon sonrası ortaya çıkan siyatik nöropati

Kas içi enjeksiyonlar, gelişmekte olan ülkelerde siyatik sinir hasarının en sık nedenidir. Piriformis sendromu, siyatik sinir primer tümörleri, sinire invazyon ya da bası yapan metastatik tümörler, endometriyozis, vasküler malformasyonlar, uzamış immobilizayon veya spesifik pozisyonlar daha nadir siyatik nöropati nedenleridir. En güvenilir tanı yöntemleri sinir ileti incelemeleri ve elektromiyografi olmakla birlikte manyetik rezonans görüntülemenin lezyon tipini belirlemek, lezyon bölge ve seviyesini kesinleştirmekte alternatif inceleme yötemi olduğu ileri sürülmektedir. Burada, sedasyon altında uzun süreli litotomi pozisyonunda kas içi enjeksiyon sonrasında gelişen siyatik nöropati olgusu sunmaktayız.

Sciatic neuropathy developed after injection during curettage

Intramuscular injections are likely the most common cause of sciatic nerve injury in developing countries. Less common causes include piriformis syndrome, primary tumors of the sciatic nerve, metastatic tumors invading or compressing the nerve, endometriosis, vascular malformations, and prolonged immobilization or positioning. While the most reliable diagnostic and prognostic methods include nerve conduction studies and electromyography, magnetic resonance imaging has been suggested as an alternative method of determining type of lesion, establishing location, and investigating level of nerve involvement. A case of sciatic neuropathy that developed after intramuscular injection, with patient in prolonged lithotomy position and under sedation, is described.

PDF

___

1. Plewnia C, Wallace C, Zochodne D. Traumatic sciatic neuropathy: a novel cause, local experience, and a review of the literature. J Trauma 1999;47(5):986-91.
2. Kimura J. Peripheral nerve diseases. Amsterdam: Elsevier; 2006.
3. Petchprapa CN, Rosenberg ZS, Sconfienza LM, Cavalcanti CF, Vieira RL, Zember JS. MR imaging of entrapment neuropathies of the lower extremity. Part 1. The pelvis and hip. Radiographics 2010;30(4):983-1000.
4. McMillan HJ, Srinivasan J, Darras BT, Ryan MM, Davis J, Lidov HG, et al. Pediatric sciatic neuropathy associated with neoplasms. Muscle Nerve 2011;43(2):183-8.
5. Floyd JR 2nd, Keeler ER, Euscher ED, McCutcheon IE. Cyclic sciatica from extrapelvic endometriosis affecting the sciatic nerve. J Neurosurg Spine 2011;14(2):281-9.
6. Van Gompel JJ, Griessenauer CJ, Scheithauer BW, Amrami KK, Spinner RJ. Vascular malformations, rare causes of sciatic neuropathy: a case series. Neurosurgery 2010;67(4):1133-42.
7. Iizuka S, Miura N, Fukushima T, Seki T, Sugimoto K, Inokuchi S. Gluteal compartment syndrome due to prolonged immobilization after alcohol intoxication: a case report. Tokai J Exp Clin Med 2011;36(2):25-8.
8. Mumby DM, Hartsilver EL. Magnetic resonance imaging of sciatic nerve compression injury after epidural blockade. Int J Obstet Anesth 2012;21(2):199-200.
9. Wang JC, Wong TT, Chen HH, Chang PY, Yang TF. Bilateral sciatic neuropathy as a complication of craniotomy performed in the sitting position: localization of nerve injury by using magnetic resonance imaging. Childs Nerv Syst 2012;28(1):159-63.
10. Sivrioglu AK, Ozyurek S, Mutlu H, Sonmez G. Piriformis syndrome occurring after pregnancy. BMJ Case Rep 2013;2013.