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Teaching Neuro Images 38 years old female with leg pain and weakness. Neurology Resident and Fellow Section. Vignette. A 38 years old female presented with acute onset of severe pain in the left calf and foot after inhaling heroin.

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teaching neuro images 38 years old female with leg pain and weakness

Teaching NeuroImages38 years old female with leg pain and weakness

Neurology

Resident and Fellow Section

vignette
Vignette
  • A 38 years old female presented with acute onset of severe pain in the left calf and foot after inhaling heroin.
  • Examination revealed distal left lower extremity weakness and absent ankle jerk.
  • HIV, CK, ESR and CRP were normal.
  • EMG findings at 8 weeks: reduced left superficial peroneal and sural sensory responses; reduced left peroneal and tibial motor responses; evidence of acute denervation in the left flexor digitorumlongus, tibialis anterior and medial gastrocnemius
  • Weekly infusions of intravenous methylprednisoloneled to improvement in her symptoms.

Kumar et al

imaging
Imaging

Kumar et al

sciatic neuropathy after heroin abuse
Sciatic neuropathy after heroin abuse
  • Both EMG and MRI confirmed a left sciatic neuropathy.
  • Recognized neuromuscular complications of acute heroin usage include mononeuropathy, polyradiculoplexopathy and rhabdomyolysis secondary to possible inflammatory or toxic mechanisms1, 2.
  • This case illustrates the value of radiological imaging in recognizing this entity.

Kumar et al