- Cases of bilateral femoral neuropathy associated with bilateral iliopsoas, psoas, or iliacus hematomas reported in the literature*
| Symptoms related to femoral neuropathy | Timing of neuropathy presentation | Positive examination findings on neuropathy presentation | Management | Outcome |
|---|---|---|---|---|
| Inability to move bilateral lower extremities | Day 16 of admission for PE/ DVT | Inability to elevate legs against gravity or to extend knees; absent leg reflexes | Conservative management | Discharged to a rehabilitation center 4 wk after neuropathy diagnosis with motor strength 4/5 in bilateral lower extremities |
| Moderate weakness in proximal lower extremities | Day 7 of hospitalization | Strength 3/5 in bilateral iliopsoas and 2/5 in quadriceps; hyperalgesia and numbness over the L2-L4 dermatomes, bilaterally | Conservative management followed by surgical decompression | At 3- and 6-month follow-up visits, full strength in lower extremities, but continued mild dysesthesias in anterolateral thighs bilaterally |
| Severe pain in anterior aspect of Rt thigh, followed next day by similar, less intense symptoms on Rt side | N/A | Reduced sensation to pinpricks in the distribution of Rt saphenous nerve; next day bilateral femoral nerve palsy more severe on the Rt than on the Lt | Conservative management followed by TAE | On discharge, 3 wk after TAE, femoral nerve function had returned to normal apart from a mild residual weakness in Rt quadriceps muscle |
| Numbness of anterior aspect of both thighs with both legs held flexed at hip joints | Second day of pain onset | Bilateral incomplete femoral nerve palsy, Rt more than Lt | Conservative management followed by bilateral surgical decompress-ion | On discharge, 3 wk after surgery, femoral nerve functions had returned to normal apart from mild residual weakness in Lt quadriceps muscle |
| Sudden Lt thigh pain, followed by complete deficit of the entire quadriceps | Several hours after hematoma symptom onset | Quadriceps score of zero and complete abolition of Lt patellar reflex; strength of Rt quadriceps and Rt patellar reflex were also diminished | Emergency surgery | Poor postoperative recovery; seven months later, Lt quadriceps deficit score retained between 3 and 4, which considerably interfered with walking |
| Paresthesias over anterior aspect of Rt thigh, radiating to medial and anterior portions of lower leg; Rt hip flexed; developed similar, less intense symptoms with on Lt side after 48 hr | N/A | Weakness of Rt quadriceps femoris; decreased sensation to pinprick in Rt saphenous nerve distribution; knee jerk: Rt 1+ and Lt 2+; ankle jerk: 1+ bilaterally; flexor plantar responses | Surgical evacuation of Rt hematoma and conservative management of Lt hematoma | All symptoms in both legs resolved within a few days, except for mild paresthesias on the Rt. |
| Pain in lower limbs, followed by inability to get up | Around the same time as hematoma presentation | Impossibility of extension of legs; remarkable reduction of flexion and adduction of thighs; absent patellar reflexes; hypoesthesia on anterior surface of thighs and middle surface of shins; findings were bilateral, but greater on Lt side | Conservative management | More than 3 mon after admission, walking was possible without support; motor deficit in lower limbs was 4th degree on Lt and 2nd degree on Rt; sensation in femoral nerve territory was remarkably improved |
| Anesthesia on medial aspect of both thighs | 48 hr after hematoma symptom onset | Bilateral flaccid paralysis of femoral nerve; absence of patellar reflex bilaterally | Immediate operation with bilateral hematoma evacuation; warfarin treatment was maintained | At 10 wk after the operation, pt was able to walk unsupported and bend knees to near sitting position; skin sensibility returned to near normal |
↵* The mechanism of hematoma in all cases was anticoagulation. N/A: not available; F: female; M: male, yr: year; wk: week; mon: month; Rt: right; Lt: left; PE: pulmonary embolism; DVT: deep vein thrombosis; DM: diabetes mellitus; COPD: chronic obstructive pulmonary disease; IV: intravenous; TIA: transient ischemic attack; MI: myocardial infarction; US: ultrasound; MCV: motor conduction velocity; TAE: transcatheter arterial embolization