MERALGIA PARESTHETICA SYNDROM AFTER TRANSFEMORAL CORONARY ANGIOGRAPHY
Abstract
A painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN), meralgia paresthetica is commonly due to focal entrapment of this nerve as it passes through the inguinal ligament. Rarely, it has other etiologies such as direct trauma, stretch injury, or ischemia. Transfemoral Coronary Angiography is the rare cause of this condition.
We diagnosed 5 patients with this syndrome from 1998-1999 as a complication of angiography. Four patients were male. Diagnosis was confirmed by physical exam and diagnostic tests (NCV, EMG). This syndrome typically occurs in isolation. The clinical history and examination is usually sufficient for making the diagnosis. However, the diagnosis can be confirmed by nerve conduction studies. Treatment is usually supportive. The LFCN is responsible for the sensation of the anterolateral, thigh. It is a purely sensory nerve and has no motor component.
The clinical syndrome is well defined, and further evaluation by electrodiagnostic .studies may be unnecessary. Evaluation with nerve conduction studies and needle examination electromyography (EMG) is warranted if no risk factors are identified, if a mass lesion in the retroperitoneal space is suspected, or if back pain also is present.
LFCN conduction studies can be technically difficult. When obtained, compare with the asymptomatic side.The EMG should be normal in LFCN lesions, but the test is helpful in ruling out upper lumbar radieulopathy. Removing the cause of compression is the best therapy. In some patients, this entails weight loss and wearing loose clothing. Most patients with meralgia paresthetica will have mild symptoms that respond to conservative management.
We diagnosed 5 patients with this syndrome from 1998-1999 as a complication of angiography. Four patients were male. Diagnosis was confirmed by physical exam and diagnostic tests (NCV, EMG). This syndrome typically occurs in isolation. The clinical history and examination is usually sufficient for making the diagnosis. However, the diagnosis can be confirmed by nerve conduction studies. Treatment is usually supportive. The LFCN is responsible for the sensation of the anterolateral, thigh. It is a purely sensory nerve and has no motor component.
The clinical syndrome is well defined, and further evaluation by electrodiagnostic .studies may be unnecessary. Evaluation with nerve conduction studies and needle examination electromyography (EMG) is warranted if no risk factors are identified, if a mass lesion in the retroperitoneal space is suspected, or if back pain also is present.
LFCN conduction studies can be technically difficult. When obtained, compare with the asymptomatic side.The EMG should be normal in LFCN lesions, but the test is helpful in ruling out upper lumbar radieulopathy. Removing the cause of compression is the best therapy. In some patients, this entails weight loss and wearing loose clothing. Most patients with meralgia paresthetica will have mild symptoms that respond to conservative management.
Keywords
Meralgia Paresthetica, Angigraphy, Lateral Femoral Cutaneous Nerve, Complication