Bilateral Femoral Neuropathy: A Rare Complication of Drug Overdose due to Prolonged Posturing in Lithotomy Position

Abstract

Background. Bilateral femoral neuropathy is an uncommon complication of various surgical and nonsurgical procedures, such as pelvic/abdominal surgery or vaginal delivery. Case Report. We report a case of a 41-year-old male who was found unresponsive against the wall in a “lithotomy-type” position with both knees flexed at approximately 90 degrees and both hips flexed and externally rotated at approximately 90 and 60 degrees, respectively, 24–48 hours after a drug overdose (combination of dihydrocodeine, paracetamol, diazepam, and amitriptyline). During his recovery, he complained of severe bilateral proximal lower limb weakness and bilateral distal lower limb pain and allodynia. His symptoms were initially attributed to critical illness myopathy/neuropathy (CIMN). However, thorough clinical and neurophysiological evaluation revealed that his symptoms were due to severe bilateral femoral neuropathies. Conclusions. To our knowledge, this is the first reported case of bilateral femoral nerve palsy due to prolonged posturing in a “lithotomy-type” position in the context of a drug overdose.

Factors associated with a maternal lower‐limb neurological deficit after vaginal delivery

“…Likewise, the genupectoral (knee–chest) position has been previously described as a risk factor for neurological deficit, particularly in the femoral and lateral femoral‐cutaneous territories, via compression under the inguinal ligament. 1 , 6 , 8 , 16 , 17 Although several cases of neurological deficit from this position have been reported—even outside the childbirth context 32 , 33 —the disappearance of this factor after logistic regression analysis suggests that any compression linked to a prolonged position may be from its duration rather than the position type. As such, frequent position changes during labor have been recommended.…”

Factors Associated With a Maternal Lower-limb Neurological Deficit After Vaginal Delivery

“…Likewise, the genupectoral (knee-chest) position has been previously described as a risk factor for neurological deficit, particularly in the femoral and lateral femoral-cutaneous territories, via compression under the inguinal ligament. 1,6,8,16,17 Although several cases of neurological deficit from this position have been reported-even outside the childbirth context 32,33 -the disappearance of this factor after logistic regression analysis suggests that any compression linked to a prolonged position may be from its duration rather than the position type. As such, frequent position changes during labor have been recommended.…”