Siyatik Sinir Enjeksiyon Nöropatileri: Bir Elektrofizyoloji Laboratuarının Tecrübesi ve Türkiye'de Medikolegal Yaklaşım

Abstract

Correspondence Address/Ya z›fl ma Ad re si: Aysegul Gunduz MD, Istanbul University Cerrahpasa School of Medicine, Department of Neurology, Istanbul, Turkey Gsm: +90 542 745 20 95 E-mail: draysegulgunduz@yahoo.com Re cei ved/Ge lis ta ri hi: 06.26.2011 Ac cep ted/Ka bul ta ri hi: 07.31.2011 © Arc hi ves of Neu ropsy chi atry, pub lis hed by Ga le nos Pub lis hing / © No rop si ki yat ri Ar si vi Der gi si, Ga le nos Ya yi ne vi ta ra f›n dan ba s›l m›fl t›r. ABS TRACT Objective: The gluteal region is usually the preferred site for intramuscular injections. However, reported complications include pain, abscess formation, hematoma formation and peripheral nerve injury, most frequently sciatic nerve injury. Here, we aimed to analyze the demographical, clinical and electrophysiological features of patients with sciatic nerve injury following gluteal intramuscular injections and to summarize the legal procedure in Turkey. Methods: We retrospectively investigated the clinical and electrophysiological features of 33 patients who were admitted to our electrophysiology department between January 1995 and June 2006 with symptoms and signs of sciatic nerve injury which appeared after intramuscular injection in the gluteal region and we reviewed the legal procedure. Results: There were 16 male (48.5%) and 17 female (51.5%) patients. Age range was between 1.5 and 81 years. The interval between nerve injury and admission to our laboratory ranged from 20 days to 25 years. 24 patients were admitted within 6 months after the injury, 32, within 1 year and, only one was admitted after 25 years. The patients who were admitted within the first 6 months after the injury, were commonly admitted for diagnosis and determination of prognosis, whereas the patients in the late periods were referred as a part of medico-legal procedure. All patients expressed burning and shock-like pain radiating to the whole lower extremity. The other symptoms were weakness (50%), numbness (9.1%), and paresthesia (4.5%). Electrophysiologically, both divisions of the sciatic nerve were affected in 9 (27.2%) and axonal involvement of the lateral division predominated in the remaining patients. Conclusion: Injection neuropathy constitutes the major part of the sciatic nerve injuries. Most frequent symptoms are burning pain and weakness. In any traumatic sciatic neuropathy, the peroneal nerve seems to be involved more frequently resulting from the more lateral and superficial location of the fibers supplying the peroneal nerve. Axonal involvement is generally predominating in injection neuropathies. Patients even in the late period are referred to the electrophysiology laboratory for determination of sequela and medico-legal procedures. All medical staff should be aware of clinical and electrophysiological findings and medicolegal approach in this condition. (Arc hi ves of Neu ropsy chi atry 2012; 49: 208-211)