Nicolau Syndrome, Masquerader of Postinjection Sciatic Nerve Injury: Case Report and Review of Literature.
Adolescent
Anti-Bacterial Agents
/ administration & dosage
Buttocks
Diagnosis, Differential
Electrodiagnosis
Fecal Incontinence
/ etiology
Glucocorticoids
/ therapeutic use
Humans
Injections, Intramuscular
/ adverse effects
Male
Neural Conduction
Nicolau Syndrome
/ complications
Penicillin G Benzathine
/ administration & dosage
Peripheral Nerve Injuries
/ diagnosis
Peroneal Neuropathies
/ etiology
Physical Therapy Modalities
Sciatic Nerve
/ injuries
Urinary Incontinence
/ etiology
Ecchymosis
Injection palsy
Lower limb weakness
Nicolau syndrome
Sciatic nerve injury
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
16
05
2020
revised:
03
07
2020
accepted:
05
07
2020
pubmed:
18
7
2020
medline:
20
4
2021
entrez:
18
7
2020
Statut:
ppublish
Résumé
Sciatic nerve injury after inadvertent intramuscular gluteal injection is a well-described entity. We have presented a case of a rare and probably underdiagnosed pathological entity, Nicolau syndrome, which can be confused with injection palsy. We report the case of a 13-year-old boy who had presented with foot drop and urinary and fecal incontinence after an intramuscular injection of benzathine penicillin in the left gluteal region. On examination, the patient had multiple ecchymoses over the left gluteal region and back of the thigh, mild swelling of the left lower limb, and left foot drop. Meticulous examination also revealed a subtle weakness of the opposite limb. Nerve conduction studies revealed axonopathy involving multiple bilateral lower limb nerves. These unusual neurological-dermatological signs and electrophysiological findings raised the concern for an alternative pathology, which was later diagnosed as Nicolau syndrome. The patient experienced clinical and electrophysiological recovery after a course of oral steroids and physiotherapy during the next few months. Before diagnosing injection sciatic nerve injury, the possibility of medically treatable Nicolau syndrome should be considered. Neurosurgeons' familiarity with this pathology and a timely diagnosis is essential to plan appropriate treatment strategies.
Sections du résumé
BACKGROUND
Sciatic nerve injury after inadvertent intramuscular gluteal injection is a well-described entity. We have presented a case of a rare and probably underdiagnosed pathological entity, Nicolau syndrome, which can be confused with injection palsy.
CASE DESCRIPTION
We report the case of a 13-year-old boy who had presented with foot drop and urinary and fecal incontinence after an intramuscular injection of benzathine penicillin in the left gluteal region. On examination, the patient had multiple ecchymoses over the left gluteal region and back of the thigh, mild swelling of the left lower limb, and left foot drop. Meticulous examination also revealed a subtle weakness of the opposite limb. Nerve conduction studies revealed axonopathy involving multiple bilateral lower limb nerves. These unusual neurological-dermatological signs and electrophysiological findings raised the concern for an alternative pathology, which was later diagnosed as Nicolau syndrome. The patient experienced clinical and electrophysiological recovery after a course of oral steroids and physiotherapy during the next few months.
CONCLUSIONS
Before diagnosing injection sciatic nerve injury, the possibility of medically treatable Nicolau syndrome should be considered. Neurosurgeons' familiarity with this pathology and a timely diagnosis is essential to plan appropriate treatment strategies.
Identifiants
pubmed: 32679363
pii: S1878-8750(20)31540-0
doi: 10.1016/j.wneu.2020.07.029
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Glucocorticoids
0
Penicillin G Benzathine
RIT82F58GK
Types de publication
Case Reports
Journal Article
Review
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
51-55Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.