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Lipoma Compressing the Sciatic Nerve in a Patient With Suspicious Central Post-stroke Pain

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주제분류재활의학

초록

Lipomas are mostly located in the subcutaneous tissues and rarely cause symptoms. Occasionally, peripheral nerve compression by lipomas is reported. We describe a case of a 59-year-old man with a left-middle cerebral artery infarction who was newly diagnosed as right basal ganglia and thalamic intracranial hemorrhage. He had neuropathic pain in the left arm and leg that was suspected to be central post-stroke pain. The administration of pain medication brought only temporary symptom relief. Nerve conduction and electromyography studies revealed left L5 radiculopathy and he showed a positive ‘sign of the buttock’ in the left hip. Left-hip magnetic resonance imaging revealed an intermuscular lipoma compressing the sciatic nerve. After surgery, the range of motion in the left hip joint was significantly increased, and the patient’s pain was relieved.

Abstract

Lipomas are mostly located in the subcutaneous tissues and rarely cause symptoms. Occasionally, peripheral nerve compression by lipomas is reported. We describe a case of a 59-year-old man with a left-middle cerebral artery infarction who was newly diagnosed as right basal ganglia and thalamic intracranial hemorrhage. He had neuropathic pain in the left arm and leg that was suspected to be central post-stroke pain. The administration of pain medication brought only temporary symptom relief. Nerve conduction and electromyography studies revealed left L5 radiculopathy and he showed a positive ‘sign of the buttock’ in the left hip. Left-hip magnetic resonance imaging revealed an intermuscular lipoma compressing the sciatic nerve. After surgery, the range of motion in the left hip joint was significantly increased, and the patient’s pain was relieved.

참고문헌 (8)

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  3. Klit H, "Central post-stroke pain: clinical characteristics, pathophysiology, and management", Lancet Neurol, 8, pp.857~868 (2009)
  4. Bugnicourt JM, "Acute peripheral nerve compression by a lipoma mimicking stroke", Clin Neurol Neurosurg, 111, pp.395~396 (2009)
  5. Botwin KP, "Sciatic neuropathy secondary to infiltrating intermuscular lipoma of the thigh", Am J Phys Med Rehabil, 80, pp.754~758 (2001)
  6. Kumar B, "Central poststroke pain: a review of pathophysiology and treatment", Anesth Analg, 108, pp.1645~1657 (2009)
  7. Greenwood MJ, "Differential diagnosis of the hip vs. lumbar spine: five case reports", J Orthop Sports Phys Ther, 27, pp.308~315 (1998)
  8. Kong KH, "Prevalence of chronic pain and its impact on health-related quality of life in stroke survivors", Arch Phys Med Rehabil, 85, pp.35~40 (2004)

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