Ciática cíclica bilateral por endometriosis. A propósito de un caso

Danny Jesús Calzada Sierra, D J Calzada-Sierra, Eduardo Fermín Hernández, E Fermín-Hernández, R Vasallo-Prieto, R. Vasallo Prieto, Lázaro Gómez Fernández, L Gómez-Fernández, AO Fe, A Santana de la Fé
Revista de neurologia · 1999 · vol. 29(01) , pp. 34 · doi:10.33588/rn.2901.99078 · PMID:10528307 · W108965012
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This case report describes cyclical bilateral sciatica caused by endometriosis, presenting with menstrual-related pain and progressive motor deficit, ultimately treated successfully with depot medroxyprogesterone.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 · read from full text ⓘ

This case report describes a woman of reproductive age who developed chronic right-sided sciatica starting at age 36 with slowly progressive motor deficit (including “pendular foot”), where pain crises coincided cyclically with menstruation. After a diagnosis of piriformis muscle syndrome at age 44 and surgical intervention (which increased sciatica crises), similar cyclic pain later emerged on the left; the authors report clinical, imaging (including contrast-enhanced pelvic CT), and electrophysiological findings. Treatment with depot medroxyprogesterone was associated with disappearance of the painful crises and satisfactory evolution. The paper explicitly notes that cyclic sciatica due to endometriosis is poorly known and can cause permanent disability, and it presents limitations inherent to a single-patient design. This paper is centrally about endometriosis — it presents a case of cyclic bilateral sciatica attributed to endometriosis involving the sciatic nerve.

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Abstract

INTRODUCTION: Cyclical sciatica due to implantation of endometrial tissue in the sciatic nerve in the region of the sciatic notch is a very unusual cause of sciatica. It occurs in women of childbearing age, as episodes of pain in the distribution of the sciatic nerve, which present in a cyclic manner and coincide with menstruation. If it is not treated, a sensomotor mononeuropathy of the sciatic nerve develops. CLINICAL CASE: The patient had complained of right-sided sciatic pain from the age of 36 years. Over the years a motor deficit had slowly and progressively appeared causing foot drop. The painful crises were related to her menstrual periods. At the age of 44 years a pyramidal muscle syndrome was diagnosed and treated surgically. This was followed by increase in the crises of sciatic pain. A year later, she started to have sciatic pain on the left side, which was similar to that of the right side. The clinical, imaging and electrophysiological findings are reported. The patient improved. She is still being treated with depot medroxyprogesterone and her pain has disappeared. CONCLUSIONS: Cyclical sciatica due to endometriosis is little known and may lead to permanent disability. Computerized axial tomography of the pelvis using contrast material is very useful for diagnosis. The use of depot medroxyprogesterone seems to be a satisfactory treatment in some patients.
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Abstract

Introducción La ciática cíclica debida a implantación de tejido endometrial en el nervio ciático en la región de la escotadura ciática es una causa muy rara de ciatalgia. Se presenta en mujeres en edad fértil, en forma de episodios de dolor del nervio ciático de presentación cíclica coincidentes con la menstruación; de no ser tratada causa una mononeuropatía sensitivomotora del nervio ciático. Caso clínico Paciente que desde los 36 años de edad comenzó con ciatalgias del lado derecho; con el transcurso de los años apareció de manera lentamente progresiva defecto motor que se manifestaba como pie péndulo. Las crisis de dolor se relacionaban con las menstruaciones. A los 44 años se diagnostica como síndrome del músculo piramidal y es intervenida quirúrgicamente incrementándose las crisis de ciatalgia. Un año después comienza a presentar ciatalgias del lado izquierdo con características similares a las que padecía en el lado derecho. Se describen los datos clínicos, hallazgos imagenológicos y electrofisiológicos. La paciente ha evolucionado satisfactoriamente, manteniendo tratamiento con medroxiprogesterona de depósito, con desaparición de las crisis dolorosas. Conclusiones La ciática cíclica por endometriosis es poco conocida y puede producir invalidez permanente. La tomografía axial computadorizada de pelvis con contraste es muy útil para su diagnóstico. El uso de medroxiprogesterona de depósito parece ser una opción terapéutica válida en algunas pacientes Caso clínico Paciente que desde los 36 años de edad comenzó con ciatalgias del lado derecho; con el transcurso de los años apareció de manera lentamente progresiva defecto motor que se manifestaba como pie péndulo. Las crisis de dolor se relacionaban con las menstruaciones. A los 44 años se diagnostica como síndrome del músculo piramidal y es intervenida quirúrgicamente incrementándose las crisis de ciatalgia. Un año después comienza a presentar ciatalgias del lado izquierdo con características similares a las que padecía en el lado derecho. Se describen los datos clínicos, hallazgos imagenológicos y electrofisiológicos. La paciente ha evolucionado satisfactoriamente, manteniendo tratamiento con medroxiprogesterona de depósito, con desaparición de las crisis dolorosas. Conclusiones La ciática cíclica por endometriosis es poco conocida y puede producir invalidez permanente. La tomografía axial computadorizada de pelvis con contraste es muy útil para su diagnóstico. El uso de medroxiprogesterona de depósito parece ser una opción terapéutica válida en algunas pacientes

Keywords

- Ciática cíclica - Diagnóstico por la imagen - Endometriosis - Escaner - Escaner cerebral - Imaginología - Medicina nuclear - Neuroimagen - Neuroimaginología - Tomografía axial computadorizada - Tomografía axial computarizada - Tomografía axial computarizada helicoidal - Tratamiento medicamentoso

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Sciatica Endometriosis Endometriosis Endometriosis Female Foot Foot Humans Medroxyprogesterone Acetate Medroxyprogesterone Acetate Menstrual Cycle Middle Aged Muscular Atrophy Muscular Atrophy Paralysis Paralysis Progesterone Congeners Progesterone Congeners Sciatica

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