Disclosures: Frank M. Nguyen: Nothing to disclose

Case Description: The patient was admitted to acute rehabilitation 3 weeks after motor vehicle accident and was nonverbal, agitated, and requiring max-total assistance for mobility and ADLs. He subsequently emerged from post-traumatic amnesia and showed gradual improvement in mobility. However, he had a persistently flaccid left ankle, weakness in left hamstrings, and absent sensation over dorsal and plantar foot. Electromyography (EMG) was performed at 6 weeks post-injury and revealed acute denervation without recruitment of motor units in multiple tibial and fibular innervated muscles as well as biceps femoris. As lumbar paraspinals and other left lower extremity muscles not innervated via a sciatic pathway were normal on EMG, a severe axonal sciatic neuropathy was suspected. Further review of outside records revealed patient presented with a small posterior left thigh puncture wound, which was irrigated and closed while attention was given to his life-threatening injuries. MRI of proximal left leg was obtained and demonstrated a transection of the sciatic nerve with 5-cm gap. Patient subsequently underwent surgical sciatic nerve reconstruction with cabled allografts.

Setting: Acute Rehabilitation Unit.

Patient: A 26-year-old male with severe TBI and major multiple trauma from a motor vehicle accident including liver laceration resulting in hemorrhagic shock and emergent exploratory laparotomy.

Assessment/Results: EMG diagnosis of sciatic nerve neurotmesis resulted in patient undergoing surgical reconstruction.

Discussion: While difficult to assess in a patient with life threatening injuries, early diagnosis of traumatic nerve injuries may assist in improved outcomes by leading to earlier surgical reconstruction. Physiatrists have a unique ability to assess such patients, including the use of EMG as an extension of physical examination.

Conclusion: In cognitively impaired patients such as those with TBI, EMG is a useful tool to evaluate for peripheral nerve lesions and can aid in determining appropriate further diagnostic workup and treatment.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/delayed-diagnosis-of-traumatic-sciatic-neuropathy-in-setting-of-severe-traumatic-brain-injury-a-case-report/