Endometriosis of the sciatic nerve

Teixeira, Alice Becker; Martins, William Alves; D’Ávila, Rui; Stochero, Luciele; Alberton, Luciele; Bezerra, Sofia; Romero, Alicia C.B.; Freitas, Paulo Eduardo Peixoto de; Silva, Carlos Eduardo da

doi:10.1590/s0004-282x2011000700032

Cited by 9 publications

(7 citation statements)

References 6 publications

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“…They proposed that this could be explained anatomically as the sigmoid "protects" the left sacral plexus. However, when we used the same methodology, reviewed all cases they referenced, and added all cases published until the time of writing (47 new cases), 13,16,21,23,26,28,29,31,32,34,35,38,42,43,45,49,50,[53][54][55] we could not confirm their finding-there was no statistically significant difference between the left and right side. We acknowledge other possible explanations such as lymphatic or hematogenous spread, but none of these theories would explain a continuous band of EM extending from the uterus to the LSP as seen in the imaging evidence presented here.…”

Section: Limitationsmentioning

confidence: 98%

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Sousa¹,

Capek

Howe

et al. 2015

FOC

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Sciatic nerve endometriosis (EM) is a rare presentation of retroperitoneal EM. The authors present 2 cases of catamenial sciatica diagnosed as sciatic nerve EM. They propose that both cases can be explained by perineural spread of EM from the uterus to the sacral plexus along the pelvic autonomie nerves and then further distally to the sciatic nerve or proximally to the spinal nerves. This explanation is supported by MRI evidence in both cases. As a proof of concept, the authors retrieved and analyzed the original MRI studies of a case reported in the literature and found a similar pattern of spread. They believe that the imaging evidence of their institutional cases together with the outside case is a very compelling indication for perineural spread as a mechanism of EM of the nerve.

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Section: Limitationsmentioning

confidence: 98%

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Sousa¹,

Capek

Howe

et al. 2015

FOC

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“…Endometriosis is a common disease characterized by the presence of endometrial tissue outside the uterus such as over, colon, and nasal mucosa (3,4). Common clinical presentations are dysmenorrhea, infertility, dyspareunia, or can be asymptomatic (4).…”

Section: Discussionmentioning

confidence: 99%

“…In reproductive-age women presenting with sciatica of unknown genesis, endometriosis must be considered (3). In recent literature, sciatica caused by endometriosis has been presented (3,4,6).…”

Section: Discussionmentioning

confidence: 99%

“…Early diagnosis and treatment is very important to minimize the nerve damage caused by recurrent cycles of bleeding and fibrosis. Endometriosis causes nerve damage by cyclic inflammation and advancing implanted ectopic uterine tissue into the epineurium and perineurium (4). Endometriosis treatment includes pain control, hormone therapy, and surgery (12).…”

Section: Discussionmentioning

confidence: 99%

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Extragenital Endometriosis; A Rare Casue of Sciatica: A Case Report

Külcü¹,

Öztürk²,

Taşdelen³

et al. 2015

Turk J Phys Med Rehab

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Endometriosis is a common disease characterized by the presence of endometrial tissue outside the uterus, such as over, colon, nasal mucosa. Furthermore, it can affect sciatic nerve as a rare presentation causing cyclic sciatica, chronic pelvic pain, paresis, and paresthesia. Early diagnosis and treatment is very important to minimize the nerve damage caused by endometrial focus on sciatic nerve. Diagnosis of sciatica due to endometriosis can be made by magnetic resonance neurography (MRN), thereby identifying abnormalities of the sciatic nerve in patients with unexplained sciatica. MRN is a sensitive tool for evaluating both the lumbosacral plexus and sciatic nerve. We described a 38-year-old female patient with cyclic sciatica for 4 years. She had an endometrial focus compressing sciatic nerve at left sciatic foramen level that was diagnosed by MRN. In this case report, we aimed to underline the importance of appropriate diagnostic tools in the patients with extraspinal sciatica.

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“…The presence of ectopic endometrial tissue in roots, lumbosacral plexus, and nerves such as the Sciatic nerve is one of the rarest features of endometriosis and its explanation is still unclear [2,4].…”

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confidence: 99%

Endometriosis of the lumbosacral plexus: report of a case with foot drop and chronic pelvic pain

et al. 2015

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Endometriosis which affects 5-10 % of females at the reproductive age, is most often found in the pelvic cavity and this estrogen-dependent inflammatory disease is one of the prevalent causes of chronic pelvic pain [1].One rare presentation of endometriosis is sciatic involvement, which presents as catamenial sciatica or foot drop [2,3].A 37-year-old nulliparous woman was referred to our clinic with a history of pelvic pain and right lower extremity associated with gait difficulty and recurrent right ankle sprains since 2 years. The pain became worse during menses.On the first assessment, there was muscle wasting and decreased deep tendon reflexes in right lower extremity. She was unable to perform the toe and heel walk test properly. During the motor strength examination, the hip flexion, foot dorsiflexion and plantar flexion were 4/5, 3/5 and 4/5 respectively. The big toe dorsiflexion and plantar flexion test were completely impaired. Slight hypoesthesia was detected in the medial aspect of the thigh (L1 and L2) and the posterior portion of the leg (S1). There were no fasciculations.Brain and panspinal MRI with and without contrast were normal. On transvaginal ultrasound, multiple leiomyofibromas were seen in the uterus. In addition to the multiple fibroids, several right ovarian cysts and asymmetries in the right sciatic region with an enhancing soft tissue in the sacrosciatic notch with thickening of the sciatic nerve were reported on CT scan and MRI of the pelvis.EMG-NCV was suggestive of partial involvement in the lumbosacral plexus.CSF analysis was within normal range without any malignant cells.Serologic findings for sarcoidosis, brucellosis, rheumatologic disorders, HIV, HBV, HCV, EBV, and CMV were negative.Due to unsatisfactory findings, we referred the patient to an expert laparoscopist to explore her pelvic cavity. During the laparoscopic procedure, because of severe mass effects of multiple myomas on the rectum and bladder, a hysterectomy was performed. Also, one of the ovarian cysts was resected from the right ovary, but no other masses were detected by the surgeon.The pathologic study revealed evidence of endometriotic cysts in the right ovary.Postoperatively, the pain decreased to some extent for 2 months, but again the patient experienced severe intractable pain in her pelvis and right lower extremity during expected menses and her gait became more abnormal.Repeat examination at 6 months revealed complete foot drop on the right side and a new EMG-NCV study showed progression in the lumbosacral plexus; therefore, we repeated a pelvic MRI which was diagnostic and showed a 4-4.5 cm lobulated lesion in the right sciatic notch involving the Sciatic nerve.

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Endometriosis of the sciatic nerve

Cited by 9 publications

References 6 publications

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Magnetic resonance imaging evidence for perineural spread of endometriosis to the lumbosacral plexus: report of 2 cases

Extragenital Endometriosis; A Rare Casue of Sciatica: A Case Report

Endometriosis of the lumbosacral plexus: report of a case with foot drop and chronic pelvic pain

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