Femoral Neuropathy and Anticoagulants

Butterfield, William C.; Neviaser, Robert J.; Roberts, Melville

doi:10.1097/00000658-197207000-00012

Cited by 44 publications

(19 citation statements)

References 10 publications

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“…The iliopsoas muscles are retroperitoneal and may cause sudden severe back pain that radiates typically to the groin area and anterolateral thigh. [234891014] Typically the hip is flexed on the involved side, thereby relaxing the iliopsoas muscle, and pain is elicited on passive extension as the iliopsoas muscle is stretched (psoas sign). [2349] In cases of large retroperitoneal hematomas, ecchymotic lesions in the flanks (Grey Turner's sign) or in the peri-umbilical area (Cullen's sign) may be noted.…”

Section: Discussionmentioning

confidence: 99%

“…The femoral nerve then travels down through the iliopsoas groove, formed by the lateral border of the psoas, medial border of the iliacus muscle and is covered by a tight, poorly distensible iliacus fascia. [3458] The femoral nerve finally leaves the pelvis by passing beneath the medial inguinal ligament to enter the femoral triangle just lateral to the femoral artery and vein. The nerve can be compressed anywhere along its course but it is particularly susceptible to compression within the body of the psoas muscle, at the iliopsoas groove and at the inguinal ligament.…”

Section: Discussionmentioning

confidence: 99%

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Bilateral iliopsoas hematoma: Case report and literature review

Basheer¹,

Jain²,

Anton³

et al. 2013

Surg Neurol Int

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Background:Clinically significant spontaneous bilateral iliopsoas hematoma is a rare complication of anticoagulation therapy. Definitive treatment of spontaneous iliopsoas hematomas is not well-established and varies between observation and surgical intervention. The intramuscular hematoma causes severe pain, muscle dysfunction, and occasionally nerve palsy with the femoral nerve most commonly affected. Most patients are neurologically normal but when a significant neurological deficit is associated with iliopsoas hematoma, optimal treatment recommendations vary. We report a case of spontaneous bilateral iliopsoas hematomas causing significant bilateral femoral nerve dysfunction.Case Description:The authors present the case of a 63-year-old female who developed bilateral femoral nerve palsy due to anticoagulation bleeding complication. Magnetic resonance imaging demonstrated large bilateral intramuscular psoas hematomas causing femoral nerve compression. Surgical evacuation and decompression of the femoral nerves was performed with rapid neurological improvement.Conclusion:Management recommendations depend on the volume and cause of the hematoma, timing of diagnosis, and the degree of neurological impairment. A conservative approach with bed rest and correction of bleeding abnormalities to allow the hematoma to spontaneously resorb has been utilized for patients with small hematomas and little to no neurological symptoms. In contrast, more aggressive recommendations have been made for patients with large hematomas, severe motor function deficits, or hemodynamic instability.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Bilateral iliopsoas hematoma: Case report and literature review

Basheer¹,

Jain²,

Anton³

et al. 2013

Surg Neurol Int

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“…16,17 Some authors recommend operative decompression of the haematoma if the patient is fit for surgery. [18][19][20][21][22][23][24] Others advocate conservative management at least initially, [25][26][27] because meta-analyses failed to demonstrate significant differences in outcomes for surgical versus conservative approaches. 28 The decision was even more complicated in our case because there was diffuse iliopsoas swelling, but no localised pathology.…”

Section: Discussionmentioning

confidence: 99%

“…Latex injected into these space spread from mid-lumbar levels to below the lesser trochanter, encircling, compressing and stretching the femoral nerve in its abdominal and sub-inguinal course. 30 Therefore, some authors suggest that femoral nerve compression is caused only when the iliacus is involved, 21,26,31 although this is not always the case. 32 There is a report of lumbar plexopathy resulting from a retroperitoneal haemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Femoral Nerve Compression and Compartment Syndrome Resulting from Influenza A–Induced Rhabdomyolysis: A Case Report

Chan

2008

J Orthop Surg (Hong Kong)

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Bilateral femoral nerve compression neuropathy caused by primary iliopsoas muscle pathology is rare. We report a case of extensive compartment syndrome of the right arm and both legs associated with bilateral femoral nerve palsy resulting from severe muscle swelling secondary to influenza A infection. Our objective is to alert physicians to the possible development of compartment syndrome in patients with influenza and severe myalgia. We also reviewed the literature on the pathophysiology and management of femoral nerve compression neuropathy.

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“…Whereas ultrason ography may fail to demonstrate a mass located close to the iliac bone, computerized tomography allows direct and clear visualizing of retroperitoneal structures [5]. If iliopsoas hematoma is diagnosed it should be removed immediately by surgical reintervention, since a high per centage of patients with such bleeding have residual disa bility and prolonged recovery time unless decompression neurolysis is performed [1,2,5]. As a prophylactic mea sure, we would advise waiting for normalization of the prothrombin time before grafting, especially in older pa tients with a history of hypertension and vascular dis ease.…”

Section: Discussionmentioning

confidence: 99%