Bilateral Sciatic Nerve Palsy: A New Presentation of Toilet Bowl Neuropathy

Abstract Background: Presentations of lower extremity compression palsies are rare and exist only in case reports. The true incidence of emergency department (ED) presentations of bilateral sciatic nerve palsy, “toilet bowl neuropathy,” is unknown. The following is a case of a 28-year-old active dut...

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Bibliographic Details
Published in:The Journal of emergency medicine 2012-10, Vol.43 (4), p.622-624
Main Authors: Dubil, Elizabeth A., MD, Dahle, James M., MD, Owens, Michael D., DO
Format: Article
Language:English
Subjects:
Adult
compression
Edema - etiology
Emergency
Female
Humans
Hypesthesia - etiology
Lower Extremity - innervation
Lower Extremity - physiopathology
Muscle Weakness - etiology
Muscle Weakness - physiopathology
Muscle Weakness - rehabilitation
Muscle, Skeletal - innervation
Muscle, Skeletal - physiopathology
neuropathy
palsy
Posture
pressure
Pressure - adverse effects
sciatic
Sciatic Neuropathy - etiology
Sciatic Neuropathy - physiopathology
Sciatic Neuropathy - rehabilitation
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Summary:Abstract Background: Presentations of lower extremity compression palsies are rare and exist only in case reports. The true incidence of emergency department (ED) presentations of bilateral sciatic nerve palsy, “toilet bowl neuropathy,” is unknown. The following is a case of a 28-year-old active duty Navy woman who presented to our ED via ambulance with bilateral sciatic nerve palsy from prolonged immobility. Objectives: This discussion reviews the historical precedence for the diagnosis and details the work-up and prognosis. Case Report: The patient presented complaining of bilateral lower extremity swelling, numbness, and an inability to walk after a prolonged, medication-facilitated sleep in an unusual position. She had significant weakness on examination and was admitted for further evaluation and care. Specialized neurologic studies were consistent with bilateral sciatic nerve palsy. Conclusion: Bilateral sciatic nerve palsy is an uncommon cause of lower extremity weakness. In the ED, other diagnoses such as Guillain-Barré syndrome, cauda equina, disk herniation, and gluteal compartment syndrome should be considered initially. The diagnosis of toilet bowl neuropathy, however, is dependent on obtaining an accurate history. This case report adds another perspective to the literature on sciatic nerve palsy recognition, diagnosis, and prognosis.
ISSN:0736-4679
2352-5029
DOI:10.1016/j.jemermed.2010.04.009