Case Of Meralgia Paresthetica Research Articles

Advancing the Diagnosis of Diabetic Neuropathies: Electrodiagnostic and Skin Autofluorescence Methods.

Diabetic neuropathy (DN) is a generic term for various neuropathies coexisting in a single patient. Clinical diagnosis alone can be misleading, yet routine electrodiagnostic studies in diabetes care are rare. Skin autofluorescence (SAF) is a recognized DN risk factor with potential screening value. This article highlights the diagnostic challenges and raises awareness of the often underdiagnosed neuropathic conditions in diabetes patients. We present common entrapment neuropathy cases from our diabetes clinic's electrodiagnosis laboratory in Iași, Romania. We selected seven type 2 diabetes patients with sensory or sensory-motor distal polyneuropathy and atypical DN presentations investigated through electroneurography (ENG) and electromyography (EMG) with the Neurosoft® EMG instrument and SAF measured by standard procedures. Subsequently, a narrative literature review was conducted. Entrapment neuropathies were diagnosed in all the patients: three carpal tunnel syndromes, two ulnar neuropathies (one proximal, one distal), one peroneal neuropathy, and one case of meralgia paresthetica. The lower-limb cases showed radiculoplexopathy, and there was one case of superficial radial nerve neuropathy. The SAF values ranged from 2.5 AU to 3.4 AU. Electrodiagnosis is essential for detecting focal neuropathies in patients with sensory-motor distal polyneuropathy. Elevated SAF levels may correlate with symptom severity, although further research, including large cohorts, is needed.

Single-Level Endoscopic TLIF Has Decreased Surgery Duration, Blood Loss, and Length of Hospital Stay While Achieving Similar 1-Year Clinical and Radiological Outcomes Compared With Conventional Minimally Invasive TLIF.

This study presents a single surgeon's experience comparing 1-year outcomes of endoscopic transforaminal lumbar interbody fusion (E-TLIF) vs minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in an Asian population. Retrospective review of consecutive patients who underwent single-level E-TLIF or MIS-TLIF by a single surgeon in a tertiary spine institution from 2018 to 2021 with 1-year follow-up. Inclusion criteria for both procedures were degenerative disc disease with grade I or II spondylolisthesis and mild to moderate central canal stenosis. Clinical outcomes assessed included surgery duration, blood loss, and length of stay. Patient-reported outcomes assessed included the visual analog score for back pain and lower limb pain, Oswestry Disability Index, and North American Spine Society Neurogenic Symptom Score. Radiographic parameters assessed included segmental lordosis, posterior disc height, listhesis, and the presence of cage migration or subsidence. Twelve E-TLIF and 34 MIS-TLIF patients were identified. E-TLIF had shorter surgery duration (165 ± 15 vs 259 ± 43 min for E-TLIF and MIS-TLIF groups, respectively; P < 0.001), reduced blood loss (83 ± 75 vs 181 ± 225 mL; P = 0.033), and decreased length of stay (1.8 ± 0.9 vs 4.7 ± 2.9 days; P < 0.001) compared with MIS-TLIF. E-TLIF and MIS-TLIF patients had significant improvements (P < 0.05) at 1 year in all patient-reported outcomes scores and radiographic parameters assessed. Both E-TLIF and MIS-TLIF patient groups also had similar postoperative patient-reported outcomes scores and radiographic parameters. No complications were recorded for E-TLIF, while MIS-TLIF had a case of dura tear and another case of meralgia paresthetica. There were no instances of cage subsidence, cage migration, or implant loosening in either group at 1 year. Although the study size was limited because E-TLIF is a relatively new technique in our institution, 1-year results demonstrate that E-TLIF can be a safe and efficacious option that achieves clinical and radiological results similar to MIS-TLIF with the additional benefits of decreased surgical duration, blood loss, and length of hospital stay. The results of this study support the effectiveness and potential advantages of endoscopic TLIF compared with MIS-TLIF.

A case of meralgia paresthetica caused by prone positioning in a COVID-19 patient with acute respiratory distress syndrome

COVID-19 critically ill patients usually require prone positioning for the treatment of respiratory failure caused by Acute Respiratory Distress Syndrome (ARDS). Prone position provides a better ventilation-perfusion compatibility, resulting in a significant improvement in oxygenation and a decrease in mortality, but prolonged prone positioning may cause Meralgia Paresthetica (MP), one of the most common mononeuropathies of the lower limb. The early diagnosis of MP is crucial to avoid a permanent damage with pain and disability, and to start immediately the correct treatment. In this article, we report a rare case of MP in a critically ill COVID-19 patient with ARDS, with the main aim to create awareness for MP among the medical team working.

Post-bariatric surgery peripheral neuropathies: Kuwaiti experience

BackgroundObesity is a major global health problem. Kuwait has a very high prevalence of obesity, and consequently, the number of bariatric surgeries is rising.ObjectivesThe aim of this study is to analyze the clinical presentation and electrodiagnostic features of peripheral nerve complications following bariatric surgery.Subjects and methodsWe retrospectively involved a convenience sample of patients presenting at a tertiary referral center and analyzed the patterns and frequency of peripheral nerve involvement, correlations with operative techniques, perioperative complications, nutritional status, possible risk factors, and functional impairment.ResultsAmong the 58 cases, 23 presented with chronic distal symmetrical sensorimotor neuropathy, 10 suffered from small fiber neuropathy, 22 had mononeuropathies, 2 patients had acute axonal sensorimotor neuropathy, and only 1 patient had lumbar plexopathy. In 22 patients, we observed mononeuropathies (10 cases of carpal tunnel syndrome, 7 cases of peroneal compression at the knee, 4 cases of ulnar neuropathies at the elbow, and 1 case of meralgia paresthetica). Rapid weight loss and protracted postoperative vomiting tended to correlate with generalized neuropathies, while focal compression with loss of the protective subcutaneous tissue pad was associated with mononeuropathies. All patients suffered from a deficiency of at least 1 micronutrient. Compliance with supplementary therapy was poor. Some post-bariatric neuropathies interfere severely with patients’ functional status.ConclusionPrevention by close follow-up, nutritional intervention, and patient education to avoid habitual postures related to nerve compression is appropriate.

Load Carriage-Related Paresthesias (Part 2): Meralgia Paresthetica.

This is the second of a two-part series addressing symptoms, evaluation, and treatment of load carriage- related paresthesias. Part 1 addressed rucksack palsy and digitalgia paresthetica; here, meralgia paresthetica (MP) is discussed. MP is a mononeuropathy involving the lateral femoral cutaneous nerve (LFCN). MP has been reported in load carriage situations where the LFCN was compressed by rucksack hipbelts, pistol belts, parachute harnesses, and body armor. In the US military, the rate of MP is 6.2 cases/10,000 personyears. Military Servicewomen have higher rates than Servicemen, and rates increase with age, longer loadcarriage distance or duration, and higher body mass index. Patients typically present with pain, itching, and paresthesia on the anterolateral aspect of the thigh. There are no motor impairments or muscle weakness, because the LFCN is entirely sensory. Symptoms may be present on standing and/or walking, and may be relieved by adopting other postures. Clinical tests to evaluate MP include the pelvic compression test, the femoral nerve neurodynamic test, and nerve blocks using lidocaine or procaine. In cases where these clinical tests do not confirm the diagnosis, specialized tests might be considered, including somatosensory evoked potentials, sensory nerve conduction studies, high-resolution ultrasound, and magnetic resonance imaging. Treatment should initially be conservative. Options include identifying and removing the compression if it is external, nonsteroidal inflammatory medication, manual therapy, and/or topical treatment with capsaicin cream. Treatments for intractable cases include injection of corticosteroids or local anesthetics, pulsed radiofrequency, electroacupuncture, and surgery. Military medical care providers may see cases of MP, especially if they are involved with units that perform regular operations involving load carriage.

Morphology of Lateral Femoral Cutaneous Nerve (LFCN) of the thigh and its clinical significance

Background: The incidence of Meralgia Paresthetica (MP) is increasing and is related to various surgical procedures. The obvious reason is that the description of Lateral femoral cutaneous nerve of thigh is inadequate. Aims and objectives: This study aims to record variations in origin of lateral femoral cutaneous nerve, to compile the findings and to analyze the clinical aspect related to variations so recorded and to compare the study to previous studies. Methodology: The study was performed on 30 formalin embalmed cadavers in the department of anatomy, Government Medical College, Patiala. The muscles of the posterior abdominal wall were exposed. The fibers of psoas major muscle were dissected from the transverse processes of lumbar vertebrae and the nerves of lumbar plexus were exposed. Results: In all the specimens, it was found that the lateral femoral cutaneous nerve was passing through the substance of psoas major muscle and emerged from its lateral border. Lateral femoral cutaneous nerve showed its origin from L2 and L3 only in 46.6% of plexuses. In the rest of the cases, it showed variations in the morphological root value. It was found to be absent in 10 plexuses. It arose directly from femoral nerve in 5 plexuses. Conclusion: Meralgia Paraesthetica (MP) is very commonly overlooked or confused with femoral or sciatic pain or other nerve root impingements. The knowledge of anatomical variations of the lateral femoral cutaneous nerve of thigh is essential to the surgeons to avoid iatrogenic injury to the nerve and to the clinicians while treating the cases of meralgia paresthetica.

Botulinum toxin for meralgia paresthetica in type 2 diabetes

Botulinum toxin has been used for a variety of neuropathic conditions in diabetes mellitus. Meralgia paresthetica is a mononeuropathy of femoral nerve seen in diabetes and obesity with an unclear etiopathogenesis. We studied the role of botulinum toxin in resistant cases of meralgia paresthetica in type 2 diabetes.

Meralgia parestésica secundária a laparoscopia cirúrgica para miomectomia. Relato de caso

BACKGROUND AND OBJECTIVES: Meralgia paresthetica is a disesthetic and / or anesthetic syndrome in the distribution of the lateral femoral cutaneous nerve. It is a compressive or traumatic mononeuropathy, characterized by burning pain and / or discomfort in the anterolateral thigh, without motor or muscle strength changes, with preserved reflexes. It has been described after several surgical procedures, including laparoscopies. This study aimed at reporting a case of meralgia paresthetica after gynecological laparoscopy and its treatment, as well as at reviewing relevant literature. CASE REPORT: Female patient, 52 yeas old, submitted to laparoscopic miomectomy who presented in the immediate postoperative period anesthesia in left anterolateral thigh. Seven days later she reported paroxysmal and disesthetic pain and pain at touch in the same topography. She was medicated with analgesics and anti-inflammatory drugs without improvement. After evaluation in the pain outpatient setting, clinical and electroneuromyographic diagnosis of meralgia paresthetica was established and treatment was started with gabapentin. There has been significant symptoms improvement so that 90 days later she presented just occasional paroxysmal pain. CONCLUSION: Meralgia paresthetica is a possible complication of laparoscopic miomectomy, the diagnosis of which is seldom considered. Conservative treatment with α2-δ calcium channel blocker anticonvulsants was effective for this patient.

Functional recovery, complications and CT positioning of total hip replacement performed through a Röttinger anterolateral mini-incision. Review of a continuous series of 103 cases

Minimally invasive approaches entail an increased risk of malpositioning and peri-operative complications. Most studies analyzed these data only on plain X-ray rather than computed tomodensitometry (CT) in assessing implant positioning. A Röttinger minimally invasive anterolateral (MIS-AL) approach provides rapid complication-free functional recovery with reliable implant positioning on CT-scan. One hundred and three primary cemented total hip replacements (THR) performed by a single surgeon using a MIS-AL approach underwent clinical assessment at six weeks and three, six and 12 months on X-ray, including CT and postoperative myoglobinemia and creatine phosphokinase (CPK). Pain, on a visual analog scale, was graded less than 1 at 36 hours; canes ceased to be used at a mean three weeks; and mean Postel-Merle-D'Aubigné score at six months was 17.36 (range, 13-18). There were ten approach-related complications (9.7%: one femoral perforation, two dislocations, two femoral neck fissures, two cases of meralgia paresthetica and three of tensor tendinitis). Mean CPK level was 390.9 ± 252μg/L (range, 88-1095μg/L) at 24 hr postoperatively and 319 ± 256μg/L (95-1028 μg/L) at 48 hr. Mean postoperative myoglobinemia was 299 ± 152.6μg/L (75-914μg/L). Mean acetabular inclination and anteversion on CT were respectively 44.7° ± 4.6° (34° - 56°) and 9.2°±9.2° (-17°-35°) and mean femoral anteversion 23.5° ± 9.4° (2°-53°). Functional recovery was quick, but with an 8.7% complications rate (excluding four cases of spontaneously resolved tendon pain). CT showed reliable cup positioning, but a wide scatter in femoral anteversion. Elevated muscle enzyme levels possibly testified to approach-related tissue attrition. The MIS-AL approach involves a learning curve to avoid femoral perforation. It provided rapid functional recovery with reliable positioning, at least for the cup, and a low rate of associated complications. III, prospective continuous study.

Meralgia paresthetica secondary to lipoma

Meralgia paresthetica (MP) consists of pain or dysthesia in the lateral thigh caused by entrapment of the lateral femoral cutaneous nerve (LFCN) underneath the inguinal ligament. The causes include iliac crest bone graft harvesting, seat belt injury associated with motor vehicle accident, diabetes mellitus, and trauma. The authors present the case of a 50-year-old woman who had a 1-year history of right-sided MP. The patient's history and the results of physical and radiological examinations were otherwise unremarkable except for the finding of a lipoma over the surface of the right sartorius muscle. Electrophysiological studies were interpreted as demonstrating peripheral neuropathy only. Conservative treatment, including heat or ice packing and local anesthetic and steroid injections, failed to control the patient's symptoms. Although sectioning or neurolysis of the LFCN appears to offer good-to-excellent results, the patient underwent excision of the lipoma. The symptoms resolved completely. To the best of the authors' knowledge this is the first case of MP associated with compression caused by a lipoma. The authors conclude that lipoma compression can cause MP, and in such cases, total excision of the lipoma may resolve the condition.

Prone Position-Related Meralgia Paresthetica after Lumbar Spinal Surgery : A Case Report and Review of the Literature

Lateral femoral cutaneous neuropathy occurring during spinal surgery is frequently related to iliac bone graft harvesting, but meralgia paresthetica (MP) can result from the patient being in the prone position. Prone position-related MP is not an uncommon complication after posterior spine surgery but there are only few reports in the literature on this subject. It is usually overlooked because of its mild symptoms and self-limiting course, or patients and physicians may misunderstand the persistence of lower extremity symptoms in the early postoperative period to be a reflection of poor surgical outcome. The authors report a case of prone position-related MP after posterior lumbar interbody fusion at the L3-4 and reviewed the literature with discussion on the incidence, pathogenesis, and possible risk factors related to this entity.

Meralgia Paresthetica: Complication Of Prone Position During Lumbar Disc Surgery

Background: Meralgia paresthetica (MP) is an entrapment neuropathy of the lateral femoral cutaneous nerve (LFCN). Prone position related MP is not a frequently seen complication. Methods: We report five cases of meralgia paresthetica after lumbar disc surgery which was performed in prone position. The level of the disc herniation was L4-5 in three patients and L5-S1 in two patients. All patients were obese. Mean height was 159.6 cm and mean weight was 89.8 kg. The main symptoms related to meralgia paresthetica were burning pain and hyperalgesia on the anterolateral aspect of the tight. Results: The complaints in all patients relieved with conservative therapy. Conclusion: The reason for meralgia paresthetica in these patients was the compression of the lateral femoral cutaneous nerve (LFCN) by the abdominal pillows at the point where it passes beneath the inguinal ligament. Although the development of meralgia paresthetica due to prone positioning during spine surgery has a benign course, care should be taken especially in the obese patients to prevent the LFCN compression by abdominal pillows.

The combination of thalidomide, cyclophosphamide and dexamethasone (ThaCyDex) is feasible and can be an option for relapsed/refractory multiple myeloma.

Thalidomide has recently proven to be a useful drug for treatment of refractory and relapsed multiple myeloma patients, up to 35% of whom achieve remission. However, little is known about the potential additive or synergistic effect upon its association with other drugs with proven efficacy in MM. The present pilot study was designed to evaluate the toxicity and response rate of the association of thalidomide, cyclophosphamide and dexamethasone (ThaCyDex) in 22 refractory or relapsed MM patients. The protocol scheduled the administration of thalidomide at escalating doses (200 to 800 mg/day), daily oral cyclophosphamide (CTX) (50 mg/day) and pulsed dexamethasone (40 mg/day, four days every three weeks). Adverse effects were moderate (grade <or=2) with only two patients in whom treatment was withdrawn due to neuropathy and severe somnolence. Infections were recorded in six patients, four requiring hospitalization for intravenous antibiotic therapy. No cases of thrombocytopenia grade >or=2 were noted. Other side effects included grade <or=2 constipation (29%), somnolence (35%) or dizziness (12%). In addition, one case of meralgia paresthetica and one with a deep venous thrombosis were noted. Two cases displayed hyperglycemia and myopathy attributed to dexamethasone, which was solved upon changing to prednisone. With a median follow-up of 12 months, 17 patients were evaluable for response; 13 (77%) responded to the therapy, including nine cases (53%) with a >50% M-component reduction (two of them with a complete remission). Only two responders have already progressed, with a projected event free survival of 51% at 12 months. Seven patients have died due to disease progression (n=5), sudden death (n=1) and infection (n=1). This study shows that ThaCyDex is a feasible and promising therapeutic approach for patients with relapsed/refractory MM.

Meralgia paresthetica, the elusive diagnosis: clinical experience with 14 adult patients.

To discuss the diagnosis and treatment of meralgia paresthetica as reported in the literature and as experienced by the author. Meralgia paresthetica is a mononeuropathy of the lateral femoral cutaneous nerve that can lead to significant disability when the diagnosis and treatment is delayed or missed. This condition is relatively common but is frequently mistaken for other disorders. Fifteen cases of meralgia paresthetica were identified in 14 patients in a private surgical practice during a 4-year period. All patients were initially treated conservatively and seven patients subsequently underwent surgical treatment. Follow-up ranged from 3 to 6 years. Conservative management consisting of local analgesics, steroids, nonsteroidal antiinflammatories, rest, and reduction or elimination of aggravating factors yielded long-lasting improvement in five patients with meralgia paresthetica. Nine patients with 10 cases of meralgia paresthetica did not benefit in the long term from conservative management. Seven of these patients, representing eight cases of meralgia paresthetica, ultimately opted for surgical management, and all obtained good long-term relief of symptoms. Surgical management of meralgia paresthetica is a viable option for patients in whom medical management fails. Based on the published literature and the author's experience, a rationale is presented for determining the appropriate surgical management of these patients.

Meralgia paresthetica as a complication of laparoscopic cholecystectomy

Many complications have been reported to occur secondary to laparoscopic cholecystectomy. We report here the first case of meralgia paresthetica during laparoscopic abdominal surgery.

Diagnosis of Meralgia Paresthetica

To the Editor.— Meralgia paresthetica (MP) is a disorder of the lateral femoral cutaneous nerve, the sensory nerve of the anterolateral aspect of the thigh. The symptoms are intermittent numbness, tingling, pain, and/or a burning sensation, often worse when standing or walking. Diagnosis utilizing contact chromothermography was recently reported in a case of MP. 1 My experience with this technique in 14 such cases yielded the following results in the affected region: six were isothermic (temperature equal to that of surrounding skin and of the opposite thigh), five were hypothermic (cool), and three were hyperthermic (warm). There was no correlation with either duration of symptoms or intensity of sensory impairment. Forty-six years ago, Dr Woltman and I 2 reported that appreciation of touch, pain and temperature was diminished in 68 per cent of 150 cases. Since then, in about 200 cases of MP, I have usually found the following sensory

Post-traumatic Meralgia Paresthetica—An Unusual Presentation

A case of meralgia paresthetica with severe skin reaction following trauma to the anterolateral aspect of the thigh is presented. Relief of the patients' symptoms was achieved by neurolysis of the lateral femoral cutaneous nerve.