title: Case report of bilateral relapsing-remitting sciatic nerve palsy during two pregnancies.
abstract: BACKGROUND
  Unlike puerperal peripheral nerve lesions, mononeuropathy during pregnancy is rarely encountered. We report a case of bilateral relapsing-remitting sciatic nerve palsy during two pregnancies. An extensive literature search in PubMed brought no similar cases.
  
  
  METHODS
  A healthy young woman presented with initially unilateral sciatic nerve palsy, which manifested and worsened during the early phases of two successive pregnancies. Electrophysiology revealed axonal lesion of the sciatic nerve with predominant affection of the peroneal part. Extensive laboratory examination including cerebrospinal fluid examination was unremarkable. MR imaging was compatible with bilateral intraneural perineurioma. Recurrent occurrence during two pregnancies and an anamnestic relationship between intermediate worsening of the paresis and the menstrual cycle suggested hormone-dependency of the tumor. However, response to repeated intravenous immunoglobuline (IVIG) therapy during pregnancy and shortly after childbirth resulted in partial reversion of foot drop. This was also indicative of an immunoneuropathy. Nerve biopsy was not performed because of clinical improvement. The precise underlying neuropathological mechanism remained unclear.
  
  
  CONCLUSIONS
  To increase knowledge and awareness of this rare entity, potential etiologies of mononeuropathies during pregnancy are discussed in the context of this case report. In the rare occasion of peripheral nerve mononeuropathy during pregnancy, in which therapeutic opportunities are limited, IVIG therapy may be an option when the etiology cannot clearly be determined after thorough medical investigation.
authors.affiliation: Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. sonjasuntrup@uni-muenster.de.
authors.forename: Sonja
authors.initials: S
authors.lastname: Suntrup-Krueger
authors.affiliation: Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. Matthias.Schilling@ukmuenster.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: Schilling
authors.affiliation: Department of Clinical Radiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. Wolfram.Schwindt@ukmuenster.de.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Schwindt
authors.affiliation: Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. heinz.wiendl@ukmuenster.de.
authors.forename: Heinz
authors.initials: H
authors.lastname: Wiendl
authors.affiliation: Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany. sven.meuth@ukmuenster.de.
authors.forename: Sven G
authors.initials: SG
authors.lastname: Meuth
mesh_terms: D000328:Adult; D001369:Axons / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000503:physiopathology; D012008:Recurrence; D012584:Sciatic Nerve / Q000473:pathology* / Q000503:physiopathology; D020426:Sciatic Neuropathy / Q000175:diagnosis* / Q000503:physiopathology