Pediatric sciatic neuropathies

Abstract

Objective: The incidence, cause, and prognosis of sciatic neuropathy in children is not well understood. We report our 30-year experience of 53 patients with pediatric sciatic neuropathies (SN).Methods: Prospective review of the history, physical examination, electrophysiologic findings, and clinical course of children with SN. Results:The etiology of SN injury was varied and included trauma (13), iatrogenic causes (13) (8 orthopedic surgeries and 5 miscellaneous surgeries), prolonged extrinsic compression and immobilization (6), tumors (7), vascular (5), idiopathic and progressive (4), infantile and nonprogressive (2), and unknown, presumed postviral (3). Electrophysiologic studies demonstrated abnormalities in motor conduction studies of the peroneal nerve in 44/53 (83%) or tibial nerve in 35/51 (67%). Sensory conduction studies were abnormal in sural nerve in 34 of 43 cases (79%), and superficial peroneal nerves in 15/25 (60%). Needle EMG was abnormal in peroneal innervated muscles in all subjects, in tibial nerve innervated muscles in 43/51 (84%), and in the hamstrings in 18/29 (62%). Prognosis for recovery was variable and depended on the etiology and the severity of the nerve injury. Mononeuropathies are uncommon in children; however, in our experience, pediatric sciatic neuropathy (SN) represents approximately one-fourth of all mononeuropathies. Conclusions:1 SN lesions may be underappreciated in childhood. We describe the clinical features of children who presented with SN over a 30-year period. Clinical assessment. Staff neurologists, neurosurgeons, or orthopedic surgeons evaluated all children in the study before EMG evaluation. A staff electromyographer reviewed the history and neurologic examination at the time of the EMG with the patient and parents/ guardians. Follow-up data were obtained by clinical examination, review of charts, telephone conversations, and occasionally a repeat EMG. Electrophysiologic evaluation.Nerve conduction studies (NCS) and needle EMG were performed in children using Dantec Counterpoint (Dantec Electronic, Tonsbakken, Skovlunde, Denmark), TECS TE42 machine (Teca Corporation, Pleasantville, NY) or the Teca TM Synergy N-EM-EMG monitoring systems (Oxford Instruments, Oxford, UK); standard filter settings were utilized. Electrophysiologic studies were performed without sedation in the majority; in rare instances, sedation was used. In each child with a suspected SN, motor NCS included responses from the extensor digitorum brevis, abductor hallucis brevis, and in some instances tibialis anterior. Sensory NCS included sural nerve and in some instances superficial peroneal nerve responses. Plantar sensory responses were studied in preference to the technically difficult sural response in infants. Contralateral limbs were studied if there was possibility of a systemic process or multiple limb involvement. Normative data were as previously published. 1 H-reflex studies and F-wave studies were performed infrequently. Muscles

Pediatric sciatic neuropathy presenting as painful leg: A case report and review of literature

“…Almost all the patients in their series (51) presented with foot drop (peroneal muscle weakness). [2] Numbness seems to be the predominant sensory symptom being present in all the cases. Pain as a sensory symptom was present in only eight out of 29 non-traumatic and non-surgical cases.…”

“…[1] Direct trauma and iatrogenic mechanism are the most common causes for SN followed by tumor, vascular, and compression injuries. [2] Detailed review of literature reveals only a rare, brief remark that associates idiopathic causes (three cases) with SN. [2]…”

“…[2] Detailed review of literature reveals only a rare, brief remark that associates idiopathic causes (three cases) with SN. [2]…”

“…[3] Prognosis for recovery is variable and depends entirely on the etiology and the severity of the nerve lesion. [2]…”

Sciatic Nerve Neuropathy Developed After Bone Marrow Aspiration in the Pediatric Patient

“…Bu sebepler arasında fraktür ile dislokasyon, kontüzyon, kompresyon sendromu, ateşli silah yaralanması ve kalça artroplastisi sayı-labilir (1,2). Pediatrik siyatik nöropatiye sebep olan etyolojik faktörler arasında ise, travma ve ortopedik cerrahiler ilk sırada yer almaktadır (3). Kemik iliği aspirasyonu, yirminci yüzyılın başla-rından itibaren kullanılmaya başlanmış olup, çoğunlukla sternum veya posterior iliak krestten uygulanan hematolojik hastalıklar için önemli bir tanı aracıdır (4).…”