077 Ectopic endometriosis in neurological practice

Ectopic endometriosis by definition describes presence of functioning ectopic endometrium outside the uterus. Author presents two cases of ectopic endometriosis causing focal neurological symptoms. 42 years old woman, with past medical history of IBS, Psoriasis, Asthma and diverticular disease, following insertion of IUD she presented with pelvic pain. Diagnosed after laparoscopy with positive histology at age of 20. Recently she developed recurrent catamenial pain in buttocks radiating down to left calf in L5 dermatoma and bilateral foot pain and tenderness when walking, she was referred to neurology clinic. Symptoms responded to treatment with GnRH agonists. Patient developed side effects and symptoms recurred when treatment was discontinued. Since complete hysterectomy with ovarectomy symptoms gradually improved. Generally healthy 28-years-old female with few year history of dysmenorrhoea presented with 6 months history of episodic pins and needles, pain in buttocks and weakness of both legs associated with menses. The symptoms become cyclic, occurring prior and during the time of period. EMG studies and spinal MRI were unremarkable, pelvic CT revealed cystic formations on both ovaries in near contact to lumbosacral plexus. She responded well to 6-month course of GnRH agonist, Leuprolide acetate. Ectopic endometriosis should be considered when evaluating reproductive-age women with recurring focal neuropathic or radicular leg pain, weakness and sensory symptoms.