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Annals of Indian Academy of Neurology
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IMAGES IN NEUROLOGY
Year : 2007  |  Volume : 10  |  Issue : 2  |  Page : 120
 

The lady who dropped her foot


Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, India

Correspondence Address:
Dheeraj Khurana
Department of Neurology, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-2327.33223

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How to cite this article:
Khurana D, Saini M, Prabhakar S. The lady who dropped her foot. Ann Indian Acad Neurol 2007;10:120

How to cite this URL:
Khurana D, Saini M, Prabhakar S. The lady who dropped her foot. Ann Indian Acad Neurol [serial online] 2007 [cited 2020 Jul 7];10:120. Available from: http://www.annalsofian.org/text.asp?2007/10/2/120/33223


A 25-year-old female presented with a three month history of tingling in the left posterior thigh and leg, gradually increasing difficulty in walking, thinning of left lower limb and pain in left leg. Examination revealed a left foot drop [Figure - 1] wasting of left hamstrings and calf and fibrotic scarring in bilateral gluteal regions. Left ankle dorsiflexion and knee flexion had power MRC grade 2/5 and left plantar flexion was MRC grade 4/5. The left ankle jerk was absent. Rest of the neurological examination was normal. Electrophysiological studies showed nonstimulable left tibial, common peroneal and sural nerves. In the past, the patient had undergone a cholecystectomy for abdominal pain. However, following the surgery, the abdominal pain persisted and she was administered injection pentazocine intramuscularly along with promethazine. The patient further revealed that subsequently, she had started self- injecting pentazocine intramuscularly since the last two years in a dose of 15-30 mg / day (1-2 ampoules) in the gluteal region on both sides [Figure - 2].

Chronic intramuscular injections of pentazocine leading to peripheral nerve compression is an uncommon consequence of muscle fibrosis due to chronic pentazocine administration.[1],[2] The temporal profile of the symptoms in this patient favour a compression neuropathy rather than injection injury which tends to produce symptoms rapidly. Self injection of pentazocine in the gluteal region resulting in compression neuropathy of the sciatic nerve due to muscle fibrosis is a novel etiology for foot drop

 
   References Top

1.Rousseau JJ, Reznik M, LeJeune GN, Franck G. Sciatic nerve entrapment by pentazocine-induced muscle fibrosis: A case report. Arch Neurol 1979;36:723-4.  Back to cited text no. 1  [PUBMED]  
2.von Kemp K, Herregodts P, Duynslaeger L, Deleu D, Bruyland M, Cham B. Muscle fibrosis due to chronic intramuscular administration of narcotic analgesics. Acta Clin Belg 1989;44:383-7.   Back to cited text no. 2  [PUBMED]  


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  [Figure - 1], [Figure - 2]



 

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