International Journal of Nutrition, Pharmacology, Neurological Diseases

CASE REPORT
Year
: 2012  |  Volume : 2  |  Issue : 1  |  Page : 74--75

Bilateral meralgia paraesthetica in a boy due to tense ascites


Ritu Karoli, Jalees Fatima 
 Department of Medicine, Era's Lucknow Medical College, Sarfarazganj, Hardoi Road, Lucknow, India

Correspondence Address:
Ritu Karoli
Department of Medicine, Era«SQ»s Lucknow Medical College, Sarfarazganj, Hardoi Road, Lucknow 226 003
India

Abstract

Meralgia paraesthetica, entrapment neuropathy of lateral femoral cutaneous nerve has been a very uncommon disease diagnosed and reported in children and adolesents. Here in, we present a case report of 15-year-old boy with chronic liver disease and portal hypertension who developed bilateral meralgia paraesthetica due to tense ascites.



How to cite this article:
Karoli R, Fatima J. Bilateral meralgia paraesthetica in a boy due to tense ascites.Int J Nutr Pharmacol Neurol Dis 2012;2:74-75


How to cite this URL:
Karoli R, Fatima J. Bilateral meralgia paraesthetica in a boy due to tense ascites. Int J Nutr Pharmacol Neurol Dis [serial online] 2012 [cited 2021 Mar 1 ];2:74-75
Available from: https://www.ijnpnd.com/text.asp?2012/2/1/74/93138


Full Text

 Introduction



Meralgia paresthetica, also known as Bernhardt-Roth syndrome, is a sensory entrapment mononeuropathy affecting the lateral cutaneous nerve of thighs and extremely rare in children and adolescents. [1] It is chiefly a disease of middle age, occuring three times more frequently in men than in women and usually unilateral. It is characterized by paraesthesia, burning pain, numbness over anterolateral aspect of thighs and most often caused by local ailments. Absence of motor weakness differentiates it from radiculopathy. It is known for centuries but nowadays it is uncommonly recognized and has become an obscure diagnosis among primary care physicians.

 Case Report



A 15-year-old boy [Figure 1] presented with complaint of gradually progressive distension of abdomen over two months duration and recent onset severe burning pain over lateral aspect of both the thighs at an interval of one week. The pain was increased during walking and in supine position. On general examination he had normal vitals, presence of pallor and pedal edema. Abdominal examination revealed generalized distension, dilated veins and presence of tense ascites. An area of hypoesthesia on the anterolateral aspects of both thighs in the second and third lumbar segment distribution was detected during sensory system examination. Rest of the examination was unremarkable. After the investigational work-up, he was diagnosed with chronic liver disease and portal hypertension possibly due to wilson's disease as his serum ceruloplasmin level was reduced to 90 mg/L (normal value 180-350 mg/L) and 24-hour urinary copper level was 965 μg (normal 20-50 μg) but liver biopsy which is the gold standard investigation could not be performed. He had no Kayser Fleischer rings in the cornea (confirmed by slit-lamp examination) and MRI brain was normal. Nerve conduction study showed delayed conduction velocity on right side but in the left it was inconclusive. Presence of massive and tense ascites led to compression of lateral cutaneous nerve of thigh which was the cause of pain in the anterolateral aspect of the thighs. The patient was treated conservatively. His symptoms improved with the treatment of ascites but there was recurrence of severe pain on right side which was treated with infiltration of bupivacaine and triamcinolone in the area 1 cm below and medial to the anterior superior iliac spine, after which he had complete relief in the pain.{Figure 1}

 Discussion



We are probably reporting the first case of bilateral meralgia paraesthetica in a boy with chronic liver disease and portal hypertension as we could search only one case report of ascites causing meralgia paraesthetica in the literature. [2] Its bilateral presentation was another interesting feature in our case since most often it is unilateral. Most of the causes of compression of lateral femoral cutaneous nerve are local and include primary lesions of the nerve root within the spinal canal or vertebral foramen, radiculitis secondary to infective process, degenerated intervertebral disc, spinal anesthesia, trauma to inguinal region, abdominal binders and seat belts, intra-abdominal or intra-pelvic conditions involving caecum and appendix. Only few generalized causes such as diabetes mellitus, obesity, pregnancy and ascites have been reported as yet. [3] The diagnosis of meralgia paraesthetica is primarily clinical although nerve conduction studies are done which may be inconclusive due to difficulty in obtaining sensory potentials from the nerve. Often, because of the unawareness these patients are subjected to unnecessary and costly investigations such as computed tomography and MRI hip by the primary care physicians to find out the cause of anterolateral thigh pain.

The initial treatment of meralgia paraesthetica is conservative and most of the patients are benefitted by analgesics, loose clothing, weight loss and use of local anesthetic and steroids. If pain is intractable, surgical interventions such as neurolysis, transposition and neurectomy can be considered. [4]

 Conclusion



Meralgia paraesthetica might be a cause of disability. Tense ascites as a cause of meralgia paraesthetica has been recognised but not reported among adolescents and children earlier.

References

1Edelson R, Stevens P. Meralgia paresthetica in children. J Bone Joint Surg Am 1994;76:993-9.
2Pauwels A, Amarenco P, Chazouilleres O, Pigot F, Calmus Y, Levy VG. Unusual and unknown complication of ascites: Meralgia paresthetica. Gastroenterol Clin Biol 1990;14:295.
3Massey EW. Sensory mononeuropathies. Semin Neurol 1998;2:177-833.
4Khalil N, Nicotra A, Rakowicz W. Treatment for meralgia paraesthetica. Cochrane Database Syst Rev 2008;3:CD004159.