Ann Rehabil Med.  2017 Jun;41(3):488-492. 10.5535/arm.2017.41.3.488.

Lipoma Compressing the Sciatic Nerve in a Patient With Suspicious Central Post-stroke Pain

• Kim JY
• Koo HJ
• Park GY
• Choi Y

• KMID: 2389466
• DOI: http://doi.org/10.5535/arm.2017.41.3.488

Abstract

Lipomas are mostly located in the subcutaneous tissues and rarely cause symptoms. Occasionally, peripheral nerve compression by lipomas is reported. We describe a case of a 59-year-old man with a left-middle cerebral artery infarction who was newly diagnosed as right basal ganglia and thalamic intracranial hemorrhage. He had neuropathic pain in the left arm and leg that was suspected to be central post-stroke pain. The administration of pain medication brought only temporary symptom relief. Nerve conduction and electromyography studies revealed left L5 radiculopathy and he showed a positive "˜sign of the buttock' in the left hip. Left-hip magnetic resonance imaging revealed an intermuscular lipoma compressing the sciatic nerve. After surgery, the range of motion in the left hip joint was significantly increased, and the patient's pain was relieved.

Keyword

Lipoma; Sciatic nerve

MeSH Terms

Arm
Basal Ganglia
Cerebral Arteries
Electromyography
Hip
Hip Joint
Humans
Infarction
Intracranial Hemorrhages
Leg
Lipoma*
Magnetic Resonance Imaging
Middle Aged
Neural Conduction
Neuralgia
Peripheral Nerves
Radiculopathy
Range of Motion, Articular
Sciatic Nerve*
Subcutaneous Tissue

Figure

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  Fig. 1 Brain-computed tomography upon first admission showed encephalomalacic change in the right basal ganglia and thalamus caused by an intracranial hemorrhage.

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  Fig. 2 Hip radiography revealed an osteophyte (arrow) in the left femoral head.

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  Fig. 3 The sign of the buttock: passive hip flexion with bent knee (B) is more limited and/or painful than straight leg raising (A).

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  Fig. 4 T2-weighted magnetic resonance imaging (MRI) of the lumbosacral area showed diffuse bulging of the L4-5 disc. Sagittal view (A) and axial view (B) at L4-5 level. T1-weighted MRI of the left hip showed deep soft tissue in the ischiofemoral space, measuring about 4.0 cm×1.1 cm×2.2 cm around the sciatic nerve. Coronal view (C) and axial view (D).

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  Fig. 5 Gross pathology of lipoma in the left hip lesion, a 4 cm×4 cm×2 cm encapsulated fatty mass between the gluteus medius and maximus that adhered to the sciatic nerve.

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