Bilateral sciatic nerve palsy: a new presentation of toilet bowl neuropathy.
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.


OBJECTIVE
This discussion reviews the historical precedence for the diagnosis and details the work-up and prognosis.


METHODS
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.


CONCLUSIONS
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.
Dubil
Elizabeth A
EA
Department of Emergency Medicine, Portsmouth Naval Medical Center, Portsmouth, Virginia 23708, USA.
Dahle
James M
JM
Owens
Michael D
MD
D000328:Adult; D004487:Edema / Q000209:etiology; D005260:Female; D006801:Humans; D006987:Hypesthesia / Q000209:etiology; D035002:Lower Extremity / Q000294:innervation / Q000503:physiopathology; D018908:Muscle Weakness / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D018482:Muscle, Skeletal / Q000294:innervation / Q000503:physiopathology; D011187:Posture; D011312:Pressure / Q000009:adverse effects*; D020426:Sciatic Neuropathy / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation