Disclosures: Christian Phillips, MD: Nothing to disclose

Case Description: Patient was admitted to the hospital after being found down at home by family. It was reported that he was found lying across his bed, positioned in lumbar hyperlordosis and hip hyperextension. Initial work up revealed a positive urine drug screen and rhabdomyolysis. Brain MRI was consistent with anoxic injury. Physical exam showed symmetric severe weakness in knee extension. At times, he had no active firing of his quadriceps musculature while his hip flexion and distal strength were all at least antigravity. He also had associated paresthesias of his anterior thighs. MRI of his lumbar spine showed canal stenosis and foraminal narrowing at L2-4 but could not fully account for these physical findings.

Setting: Acute Inpatient Rehabilitation

Patient: 47-year-old male

Assessment/Results: Lower extremity EMG 5 months later showed normal nerve conduction studies with abnormal electromyography demonstrating evidence of significant denervation of the femoral nerve innervated muscles bilaterally. There was no denervation noted in lumbar paraspinals on limited exam. These findings are consistent with bilateral femoral nerve injury and are most likely explained by patient positioning causing femoral nerve stretch injuries.

Discussion: Bilateral femoral neuropathies are uncommon. Those caused by stretch injury secondary to prolonged unfavorable positioning are even more rare. One literature review performed by Mathis et al. in 2012 found only 29 reported cases of bilateral femoral nerve injuries. All but 2 were accounted for by local compression from trauma, surgery, or obstetric related complication. They described a case of bilateral femoral nerve neuropathy secondary to a stretch mechanism injury from positioning of hip extension and back hyperlordosis following a suicide attempt. This is the same proposed mechanism of injury in our case.

Conclusion: This is a unique presentation of bilateral femoral neuropathy likely caused by an atypical stretch injury in the setting of anoxic brain injury.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/isolated-bilateral-femoral-nerve-injury-in-the-setting-of-anoxic-brain-injury-a-case-report/