Pediatric Sciatic Neuropathies Due to Unusual Vascular Causes

Srinivasan, Jayashri; Escolar, Diane; Ryan, Monique M.; Darras, Basil T.; Jones, H. Royden

doi:10.1177/0883073808314163

Cited by 12 publications

(7 citation statements)

References 9 publications

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“…29 One child had umbilical artery catheterization and following the procedure developed SN. The likely pathogenesis is thromboembolism of the inferior gluteal artery and ischemia of the sciatic nerve.…”

Section: Prolonged Compression or Immobilization (6)mentioning

confidence: 99%

Pediatric sciatic neuropathies

Srinivasan¹,

Ryan

Escolar³

et al. 2011

Neurology

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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

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Section: Prolonged Compression or Immobilization (6)mentioning

confidence: 99%

Pediatric sciatic neuropathies

Srinivasan¹,

Ryan

Escolar³

et al. 2011

Neurology

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“…In the lower limbs, sciatic neuropathy in childhood has been associated with trauma, iatrogenic causes, compression, various tumors, including perineurioma, and sometimes has vascular causes, including occlusion of the inferior gluteal artery . The other major mononeuropathy in the lower limbs, fibular (peroneal) neuropathy, has been associated with compression, trauma, and entrapment .…”

Section: Resultsmentioning

confidence: 99%

Utility and practice of electrodiagnostic testing in the pediatric population: An AANEM consensus statement

et al. 2020

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Nerve conduction studies and needle electromyography, collectively known as electrodiagnostic (EDX) studies, have been available for pediatric patients for decades, but the accessibility of this diagnostic modality and the approach to testing vary significantly depending on the physician and institution. The maturation of molecular diagnostic approaches and other diagnostic technologies such as neuromuscular ultrasound indicate that an analysis of current needs and practices for EDX studies in the pediatric population is warranted. The American Association of Neuromuscular & Electrodiagnostic Medicine convened a consensus panel to perform literature searches, share collective experiences, and develop a consensus statement. The panel found that electrodiagnostic studies continue to have high utility for the diagnosis of numerous childhood neuromuscular disorders, and that standardized approaches along with the use of high-quality reference values are important to maximize the diagnostic yield of these tests in infants, children, and adolescents. K E Y W O R D S adolescents, children, electrodiagnostic medicine, electromyography, infants, neuromuscular disorders, pediatric

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“…Through sensory branches of the tibial (sural, medial, and lateral plantar; and calcaneus) and the superficial peroneal nerves, it supplies sensation to the foot and posterior lower leg. As a consequence, sciatic neuropathies present with weakness below the knee and numbness over the calf and foot, and the ankle reflex is usually absent [1,5]. Although the vast majority of sciatica is due to degenerative causes and is radicular in nature, various other causes are to be considered when spine imaging is negative [3].…”

Section: Discussionmentioning

confidence: 99%

“…Lower extremities AVMs most commonly manifest with dermatological signs including discoloration and swelling. Development of peripheral neuropathy due to AVM compression is very rare [3,5,11].…”

Section: Discussionmentioning

confidence: 99%

An arteriovenous malformation as a rare cause of sciatic neuropathy: a case report

Akar¹,

Akgün²,

Akmil

2017

The European Research Journal

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Sciatica is characterized by pain and discomfort occurring frequently with impingement at the level of spinal nerve along the regions innervated by the sciatic nerve. Compression and irritation of the nerve often occurs with a spinal cause such as lumbar disc hernia or spinal stenosis. Compression of the nerve by an arteriovenous malformation is very rare among the causes leading to non-discogenic sciatic neuropathy. Herein, we reported our case with clinically and electrophysiologically typical sciatic neuropathy and treated by us surgically. To our knowledge, cases with arteriovenous malformation-caused sciatica were limited in the literature review. Electromyography should be performed to exclude the nerve compression due to rare causes such as vascular causes which may lead to sciatic neuropathy in patients with sciatic distribution symptoms and signs, after initial negative spine imaging.

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Pediatric Sciatic Neuropathies Due to Unusual Vascular Causes

Cited by 12 publications

References 9 publications

Pediatric sciatic neuropathies

Pediatric sciatic neuropathies

Utility and practice of electrodiagnostic testing in the pediatric population: An AANEM consensus statement

An arteriovenous malformation as a rare cause of sciatic neuropathy: a case report

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