Assistant Professor Washington University School of Medicine ST LOUIS, Missouri, United States
Case Diagnosis: Acute femoral neuropathy
Case Description: A 72-year-old male underwent cardiac catheterization through the right groin. The next day, he developed dysesthesia, numbness, and weakness in the right anterior thigh, eventually leading to multiple falls. Electrodiagnostic testing performed one month later revealed spontaneous activity and reduced motor unit recruitment in the right iliopsoas and quadriceps muscles, consistent with an acute femoral neuropathy. MRI revealed a lymphocele measuring 8.4x2.4x2.0 cm in the right groin, inseparable from the right femoral nerve. Gabapentin provided some relief, but given the risk for permanent weakness, he underwent surgical decompression and neurolysis of the right femoral nerve with sural cable autograft. By 5-month post-operatively, he was pain-free and able to climb stairs.
Discussions: Femoral neuropathy following cardiac catheterization is rare, with incidence as low as 0.004%. Symptom onset can be rapid. One retrospective study found that patients recognized symptoms an average of 37 hours following catheterization. There is no consensus on management of this complication following catheterization, but there have been reported cases of spontaneous resolution of motor and sensory femoral neuropathy in individuals with expectant management only. Neurolysis has been described to be beneficial for a variety of settings from oncological pain to spasticity, but there are no reports of using it for routine management of femoral neuropathy. Physiatrists should be cognizant of surgical neurolysis as an option for treatment of acute post-procedure peripheral neuropathy if conservative management fails, as it requires time-sensitive referral for surgery.
Conclusions: Surgical neurolysis can be an effective treatment for weakness due to acute, post-procedure peripheral neuropathy.