Abstract
Objective: To raise awareness about the diagnostic value of both cyclic sciatica and the use of MRN for the diagnosis of endometriosis involving peripheral nerves.
Background: Endometriosis prevalence is around 1–7% in young women. Cyclic sciatica due to endometriosis was first described in 1955. Invasion of the nerve generates pain and motor disorders leaving disability due to external compression, perineural invasion, hemoglobin deposition and release of inflammatory cytokines. The neuropathic pain that at first is cyclic, later becomes chronic and independent of the menstrual cycle. The MR neurography (MRN) helps in its recognition and management decisions.
Design/Methods: Description of a clinical case and review of literature.
Results: A 35-year-old female patient consulted for right low back pain extending along her posterior thigh, calf and foot since 2 years. The pain was recurrent, acute in onset, lasted several days and gradually diminished until disappearing. It was refractory to common analgesics and during the crisis she had difficulties to walk. Neurologist requested a calendar of pain in which the relationship between the menstrual cycle and the pain became evidenced. We performed MRN of the lumbo sacral plexus that showed multiple endometriotic implants in ovaries, L5-S1 roots and a huge one on the sciatic nerve (intra and extrapelvic segment). The patient started oral contraceptives but presented progressive worsening of pain until it became constant and developed step page. Electromyogram showed acute and chronic axonal damage in the sciatic nerve distribution. Medical treatment was changed to leuprolide acetate. The patient evolved with improvement of ovarian endometriosis but persistence of sciatic nerve lesions, leg pain and weakness up to now. Surgical option was considered.
Conclusions: A high clinical suspicion is necessary for early diagnosis and treatment of endometriosis related neural damage. MRN is a valuable tool to identify the lesion and to guide surgical treatment.
Disclosure: Dr. Uribe Roca has nothing to disclose. Dr. Bandeo has nothing to disclose. Dr. Saucedo has nothing to disclose. Dr. Bala has nothing to disclose. Dr. Binaghi has nothing to disclose. Dr. Chertcoff has nothing to disclose. Dr. Binaghi has nothing to disclose. Dr. Bala has nothing to disclose. Dr. Marchesoni has nothing to disclose. Dr. Leon Cejas has nothing to disclose. Dr. Pacha has nothing to disclose. Dr. Bonardo has nothing to disclose. Dr. Fernandez Pardal has nothing to disclose. Dr. Reisin has nothing to disclose.
Disputes & Debates: Rapid online correspondence
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