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Johal KS, Platsas L, Chen HC. Chronic sciatic nerve compression secondary to arteriovenous malformation: case discussion and literature review. Ann R Coll Surg Engl 2021; 103:e278-e281. [PMID: 34431690 DOI: 10.1308/rcsann.2020.7134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Sciatic nerve symptomatology may arise from both intra- and extra-neural pathology, at any point along descent from the sacral plexus to its bifurcation. The potential aetiology is broad, ranging from degenerative spinal disease to muscle, bony and vascular pathology. We present an extremely unusual case of position and exercise-induced nerve compression secondary to arteriovenous malformation and review the potential extraspinal causes, many of which may be ameliorated by surgical excision or decompression. We further discuss the usefulness of diagnostic imaging, specific clinical tests and histopathological tools that may aid in management.
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Affiliation(s)
- K S Johal
- China Medical University Hospital, Taichung, Taiwan.,St Thomas' Hospital, UK
| | - L Platsas
- China Medical University Hospital, Taichung, Taiwan
| | - H-C Chen
- China Medical University Hospital, Taichung, Taiwan
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Siddiq MAB, Clegg D, Hasan SA, Rasker JJ. Extra-spinal sciatica and sciatica mimics: a scoping review. Korean J Pain 2020; 33:305-317. [PMID: 32989195 PMCID: PMC7532296 DOI: 10.3344/kjp.2020.33.4.305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 11/21/2022] Open
Abstract
Not all sciatica-like manifestations are of lumbar spine origin. Some of them are caused at points along the extra-spinal course of the sciatic nerve, making diagnosis difficult for the treating physician and delaying adequate treatment. While evaluating a patient with sciatica, straightforward diagnostic conclusions are impossible without first excluding sciatica mimics. Examples of benign extra-spinal sciatica are: piriformis syndrome, walletosis, quadratus lumborum myofascial pain syndrome, cluneal nerve disorder, and osteitis condensans ilii. In some cases, extra-spinal sciatica may have a catastrophic course when the sciatic nerve is involved in cyclical sciatica, or the piriformis muscle in piriformis pyomyositis. In addition to cases of sciatica with clear spinal or extra-spinal origin, some cases can be a product of both origins; the same could be true for pseudo-sciatica or sciatica mimics, we simply don’t know how prevalent extra-spinal sciatica is among total sciatica cases. As treatment regimens differ for spinal, extra-spinal sciatica, and sciatica-mimics, their precise diagnosis will help physicians to make a targeted treatment plan. As published works regarding extra-spinal sciatica and sciatica mimics include only a few case reports and case series, and systematic reviews addressing them are hardly feasible at this stage, a scoping review in the field can be an eye-opener for the scientific community to do larger-scale prospective research.
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Affiliation(s)
- Md Abu Bakar Siddiq
- Physical Medicine and Rehabilitation Department, Brahmanbaria Medical College, Brahmanbaria, Bangladesh.,School of Health Sport and Professional Practice, University of South Wales, Pontypridd, United Kingdom
| | - Danny Clegg
- School of Health and Social Care, London South Bank University, London, United Kingdom
| | - Suzon Al Hasan
- Physical Medicine and Rehabilitation Department, Rajshahai Medical College, Rajshahai, Bangladesh
| | - Johannes J Rasker
- Faculty of Behavioral Management and Social Sciences, Psychology Health and Technology, University of Twente, Enschede, The Netherlands
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Adam A, Farnsworth R. Catastrophic haemorrhage from ureterocele incision in an infant: beware of an associated iliac arteriovenous malformation. ANZ J Surg 2016; 86:942-944. [PMID: 25056738 DOI: 10.1111/ans.12785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmed Adam
- Department of Paediatric Urology, Sydney Children's Hospital Network (Sydney Children's Hospital and Children's Hospital at Westmead), Sydney, New South Wales, Australia
| | - Robert Farnsworth
- Department of Paediatric Urology, Sydney Children's Hospital Network (Sydney Children's Hospital and Children's Hospital at Westmead), Sydney, New South Wales, Australia
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Mangold S, Ketelsen D, Syha R, Balletshofer B, Kalender G, Kramer U, Claussen CD, Brechtel K. Endovascular treatment of a real inferior gluteal artery aneurysm associated with a pelvic arteriovenous malformation. Cardiovasc Intervent Radiol 2011; 34:1102-5. [PMID: 21431977 DOI: 10.1007/s00270-011-0131-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Van Gompel JJ, Griessenauer CJ, Scheithauer BW, Amrami KK, Spinner RJ. Vascular Malformations, Rare Causes of Sciatic Neuropathy: A Case Series. Neurosurgery 2010; 67:1133-42; discussion 1142. [DOI: 10.1227/neu.0b013e3181ecc84e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Sciatica is typically a clear-cut symptom complex commonly related to an impingement at the spinal nerve level. Etiologies of sciatic neuropathy outside the neural foramina are uncommon.
OBJECTIVE:
To describe 4 patients presenting with radiating leg pain due to sciatic nerve involvement, all with a vascular etiology.
METHODS:
Four patients presenting with neuropathic pain were retrospectively reviewed. Preoperative 3 Tesla magnetic resonance imaging was used to identify these lesions, which most commonly showed diffuse T2 changes with nerve enhancement upon administration of contrast.
RESULTS:
Exploration revealed vascular lesions. All patients went on to external and limited internal neurolysis of the involved sciatic nerve segment. Intraoperative histological study confirmed the presence of a venous angioma, an arteriovenous malformation, a venous malformation associated with Klippel-Trenaunay syndrome, and a capillary hemangioma. Follow-up demonstrated stable neurological examinations with reduction in pain at 1 year or greater.
CONCLUSION:
In patients with sciatic distribution symptoms and signs, after initial negative spine imaging, high-resolution imaging of the sciatic nerve itself should be undertaken to address rarer causes such as vascular abnormalities. In these cases, exploration and fascicular biopsy provided a diagnosis; external and limited internal neurolysis improved pain.
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Agarwal S, Magu S, Goyal M. Pelvic arteriovenous malformation: an important differential diagnosis of a complex adnexal mass. J Ultrasound Med 2009; 28:1111-1114. [PMID: 19643798 DOI: 10.7863/jum.2009.28.8.1111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Shalini Agarwal
- Department of Radiodiagnosis, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India.
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Richards AJ, Hatrick A, Eden CG. Large pelvic arteriovenous malformation complicating laparoscopic radical prostatectomy. Urology 2008; 72:1359-61. [PMID: 18400274 DOI: 10.1016/j.urology.2008.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Revised: 12/15/2007] [Accepted: 01/02/2008] [Indexed: 11/15/2022]
Abstract
Pelvic arteriovenous malformations (AVM) are rare, usually congenital, lesions, which can pose significant difficulties for pelvic surgeons. We present a case of an AVM complicating laparoscopic radical prostatectomy. Unexpected failure of preoperative control led to significant intraoperative difficulty. The advantages of an antegrade approach and optimal magnification afforded by the laparoscopic approach led to successful completion of the operation with minimal morbidity.
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Affiliation(s)
- Andrew J Richards
- The Hampshire Clinic, Old Basing and Frimley Park Hospital, Frimley, United Kingdom.
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Game X, Berlizot P, Hassan T, Joffre F, Chokairi S, Houlgatte A, Rischmann P. Congenital pelvic arteriovenous malformation in male patients: a rare cause of urological symptoms and role of embolization. Eur Urol 2002; 42:407-12. [PMID: 12361908 DOI: 10.1016/s0302-2838(02)00355-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Congenital pelvic arteriovenous malformations (pAVM) are rare in male patients. The purpose of our study was to obtain information about the presenting symptoms, differential diagnosis, radiological diagnosis and therapy. PATIENTS AND METHODS The record of two men with congenital pAVM were reviewed to evaluate the initial symptomatology, diagnostic examinations and findings, therapeutic procedures and clinical outcome. Furthermore, our data are compared to the findings of all men reported in the literature. RESULTS Including the two cases reported by us, the data on 17 men with congenital pAVM could be analyzed. Most men presented with unspecific symptoms like pelvic discomfort, pain, impotence or dysuria. The radiological diagnosis was established by magnetic resonance imaging (MRI) or by computed tomography (CT) and was confirmed by angiography in all cases. Therapy consisted of surgical excision in nine cases, embolization in four cases, embolization and surgery in three cases and medical supervision in one case. CONCLUSION Pelvic arteriovenous malformations in male patients are rare. Because of the lack of specific symptoms, they are difficult to diagnose. CT or MRI and arteriography make the diagnosis. Intra-arterial embolization can be considered as the first line treatment.
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Affiliation(s)
- Xavier Game
- Service d'Urologie et de Transplantation Rénale, Centre Hospitalo-Universitaire Rangueil, 1 avenue Jean Poulhes, 31403 Toulouse Cedex 04, France
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Farkas E, De Jong GI, Apró E, De Vos RA, Steur EN, Luiten PG. Similar ultrastructural breakdown of cerebrocortical capillaries in Alzheimer's disease, Parkinson's disease, and experimental hypertension. What is the functional link? Ann N Y Acad Sci 2000; 903:72-82. [PMID: 10818491 DOI: 10.1111/j.1749-6632.2000.tb06352.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The brain, as an intensely active organ, is highly dependent on a sufficient nutrient and oxygen availability in order to reach its optimal working capacity. It is well known that the vital supply of energy substrates is provided by the circulatory system, which splits up into a fine, terminal capillary network in target tissues. These capillaries are considered as important sites, since the actual nutrient trafficking takes place through their walls. That is why an intact, preserved structure of the microvessels is crucial to fulfill their function. Since the brain is known to be particularly vulnerable to suboptimal oxygen and glucose delivery, the intact morphology of capillaries is of paramount importance. Several observations have indicated that the cerebral capillary ultrastructure is damaged in Alzheimer's disease (AD). Curiously, the regional cerebral blood flow of AD patients is also significantly lower than in age-matched control individuals. Based on these data, it has been suggested that the decreased blood supply and the cerebrovascular alterations contribute to the development of dementia. However, we have observed similar capillary damage in Parkinson's disease patients and chronically hypertensive rats in addition to AD cases, as presented here. These findings indicate that cerebral capillary damage is not exclusive for AD but occurs under other neurodegenerative disorders and hypertension, as well. We hypothesize that ultrastructural abnormalities of cerebral capillaries are causally related to decreased cerebral blood flow and create a condition that favors neurodegenerative mechanisms including the development of dementia.
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Affiliation(s)
- E Farkas
- Department of Animal Physiology, Graduate School of Behavioral and Cognitive Neurosciences, University of Groningen, The Netherlands.
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Abstract
Congenital pelvic arteriovenous malformations are rare entities, especially in males. Presenting symptoms, if any at all, are commonly a mass, thrill, bruit, or pain. Treatment options include surgical extirpation, embolization, or a combination of both. This case provides support for the last option in a patient presenting with symptoms localized to the seminal vesicles.
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Affiliation(s)
- S L Richards
- Department of Urology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, New York, USA
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Abstract
Behavioural disorders in Parkinson's disease can grossly be subdivided in primary disturbances and those which are related to drug treatment. Depression and anxiety are a common feature in parkinsonian patients. Both occur independently of drug treatment. In general, most current antidepressive and anxiolytic drugs could be administered in Parkinson's disease with the same precautions as in the normal population. However, in single case reports modern serotonin reuptake blockers in Parkinson's disease have been accused to worsen parkinsonian motor condition. Combinations of serotonin reuptake inhibitors with MAO-inhibitors like selegiline should be used with caution. In the case of cognitive decline firstly an underlying depression should be disclosed or if existent be treated. Depression seems to be the single most important factor associated with the severity of dementia and early antidepressant treatment seems to decrease cognitive decline in depressed parkinsonian patients. Anticholinergic medications should be discontinued since they may cause mental side effects. Sleep disorders in Parkinson's disease are mainly caused by nocturnal akinesia, which causes sleep fragmentation or altered dreaming and nightmares, which might be a side-effect of dopaminergic treatment. In the first case the administration of a controlled release preparation of levodopa at bedtime may be indicated. If the sleep disorder is considered to be due to dopaminergic medication, a reduction of long-term acting agents like modern dopamine agonists and controlled-release levodopa should be considered. In severe psychotic states related to drug treatment antiparkinsonian therapy must be carefully analysed and, if possible, reduced. If motor condition worsens and/or psychiatric symptoms do not improve, initiation with "atypical" neuroleptics like clozapine is indicated. The pharmacological and clinical properties of new antipsychotic drugs that can be used in Parkinson's disease are revised.
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Affiliation(s)
- F Valldeoriola
- Parkinson's Disease and Movement Disorders Unit, Hospital Clínic i Provincial de Barcelona, Institut Pi Sunyer, University of Barcelona, Spain
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Abstract
This pictorial review illustrates the cross-sectional imaging of several less common manifestations of aortoiliac disease. Despite their varying clinical features, the imaging appearances with ultrasound, CT and MRI will allow a correct assessment in most cases.
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Affiliation(s)
- J F Griffith
- Department of Diagnostic Radiology & Organ Imaging, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong
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