Abstract
Background: Presentations of lower extremity compression palsies are rare and exist
only in case reports. The true incidence of emergency department (ED) presentations
of bilateral sciatic nerve palsy, “toilet bowl neuropathy,” is unknown. The following
is a case of a 28-year-old active duty Navy woman who presented to our ED via ambulance
with bilateral sciatic nerve palsy from prolonged immobility. Objectives: This discussion
reviews the historical precedence for the diagnosis and details the work-up and prognosis.
Case Report: The patient presented complaining of bilateral lower extremity swelling,
numbness, and an inability to walk after a prolonged, medication-facilitated sleep
in an unusual position. She had significant weakness on examination and was admitted
for further evaluation and care. Specialized neurologic studies were consistent with
bilateral sciatic nerve palsy. Conclusion: Bilateral sciatic nerve palsy is an uncommon
cause of lower extremity weakness. In the ED, other diagnoses such as Guillain-Barré
syndrome, cauda equina, disk herniation, and gluteal compartment syndrome should be
considered initially. The diagnosis of toilet bowl neuropathy, however, is dependent
on obtaining an accurate history. This case report adds another perspective to the
literature on sciatic nerve palsy recognition, diagnosis, and prognosis.
Keywords
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Article info
Publication history
Published online: May 26, 2010
Accepted:
April 4,
2010
Received in revised form:
November 23,
2009
Received:
September 9,
2009
Footnotes
Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.
Identification
Copyright
Published by Elsevier Inc.
