Endometriosis of the sciatic nerve

Teixeira AB, Alice Becker Teixeira, Martins WA, William Alves Martins, William A Martins, d'Ávila R, Rui d'Ávila, R Daniela Dávila, Stochero L, Luciele Stochero, Alberton L, Luciele Alberton, Luciele Zibetti Alberton, Bezerra S, Sofia Bezerra, Alicia C B Romero, Romero AC, Freitas PE, Paulo Eduardo Peixoto De Freitas, Paulo E Freitas, Silva CE, Carlos Eduardo da Silva
Arquivos de neuro-psiquiatria · 2011 · vol. 69(6) , pp. 995–996 · doi:10.1590/s0004-282x2011000700032 · PMID:22297898 · W2022184538
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This paper presents a case of endometriosis affecting the sciatic nerve, a rare presentation characterized by cyclic sciatica, paresthesia, and paresis, and reviews relevant literature.

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This paper reports a single case of endometriosis involving the sciatic nerve in a 26-year-old woman with a long history of progressive lower-limb pain and weakness that worsened during menstruation, along with dorsiflexion paresis. Using neurologic examination, MRI showing an expansive lesion in the left sciatic nerve/gluteal topography, microsurgical excision, neuropathology, and postoperative MRI and ENMG, the authors identified the lesion as an endometrioma; postoperative imaging showed no residual tumor while dorsiflexion paresis persisted early and ENMG suggested a subacute denervatory process. The authors also review the literature on cyclic sciatica related to endometriosis and discuss proposed mechanisms and diagnostic considerations, emphasizing that definitive diagnosis is anatomopathological. This paper is centrally about endometriosis — specifically endometriosis of the sciatic nerve presenting as cyclic sciatica.

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Abstract

Endometriosis is a common disease, which affects 5-10% of women in fertile age 1 . It can affect multiple organs, such as ovaries, lungs, colon, nasal mucosa and brain 2 . Endometriosis of the sciatic nerve is a rare presentation 3 , manifesting as cyclic sciatica, parestesis and paresis with loss of deep tendon reflex. We cite a case of sciatica endometriosis and make a review of the literature.
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Discussion

Endometriosis is a chronic recurrent pathology, char- acterized by proliferation of endometrial tissue outside the uterine cavity 4. Typical locations include the ova - ries, uterosacral ligaments, pelvic peritoneum, vagina 2. Common clinical presentations are dysmenorrhea, in - fertility, dyspareunia, dysuria, or it can be asymptomatic. The occurrence of endometrial tissue in the nerve root is a rare location, which was related for the first time in 1946 by Schlicke 5. Cyclic sciatic is a rare symptom of endometriosis. Salazar-Grueso and Roos describe a mean Figure. Hemorrhagic stroma with endometrial epithelium. Arq Neuropsiquiatr 2011;69(6) 996 Letters interval of 3.7 years between the onset of symptoms and diagnosis. The typical symptom is cyclic sciatica related to the menstrual period, with painless intervals that be - come shorter each time until the pain becomes constant. Other symptoms are sensory loss, muscle weakness, re - flex alterations, and a positive Lasègue’s sign. Presumably, endometriosis causes nerve damage by cyclical inflammation 4. The ectopic uterine tissue once implanted in the nerve, advances aggressively the epineu- rium and perineurium. Diagnosis can be made by an association of the symp- toms to menstrual periods, and MRI findings. In the MRI it can be presented as a hiperintense solid or cystic mass. The signal intensity is due to the quantity and time of the bleeding. Further, the MRI can be useful in the dif - ferential diagnosis between a benign neurogenic tumor and the endometrioma. ENMG can demonstrate signs of denervation and a diminished conduction time, being useful to follow nerve recovery. However, a definitive di- agnosis only can be made by the anatomopathological. Endometriosis treatment involves pain control, hor - mone therapy and, for severe cases, surgical resection of the lesions1. Endometriosis invading the sciatic nerve is a rare manifestation of a common disease. Early diagnosis and treatment is very important to minimize the nerve damage caused by recurrent cycles of bleeding and fi - brosis, which are characteristics of endometriosis.

References

1. Fraser IS. Recognising, understanding and managing endometriosis. J Hum Reprod Sci 2008;1:56-64. 2. Zager EL, Pfeifer SM, Brown MJ, et al. Catamenial mononeuropathy and radiculopathy: a treatable neuropathic disorder. J Neurosurg 1998; 88: 827-830. 3. Baker GS, Parsons WR, Welch JS. Endometriosis within the sheath of the sciatic nerve. J Neurosurg 1966;25:652-656. 4. Lu PY, Ory SJ. Endometriosis: current management. Mayo Clin Proc 1995; 70:453-463. 5. Schlicke CP. Ectopic endometrial tissue in the thigh. JAMA 1946;132:445. ENDOMETRIOSE DO NERVO CIÁTICO Department of Neurosurgery and Skull Base Surgery, Hospital Ernesto Dornelles; Porto Alegre RS, Brazil: 1Medical Student; 2PhD; 3MD. Correspondence: Alice Becker Teixeira - Av. Protásio Alves 3563 / apto 23 - 90410-003 Porto Alegre RS - Brasil. E-mail: [email protected] Received 29 May 2011. Received in final form 8 July 2011. Accepted 15 July 2011.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Sciatic Neuropathy Adult Endometriosis Endometriosis Female Humans Magnetic Resonance Imaging Sciatic Neuropathy Sciatic Neuropathy

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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