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Teaching Neuro Images 38 years old female with leg pain and weakness

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

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  1. Teaching NeuroImages38 years old female with leg pain and weakness Neurology Resident and Fellow Section

  2. 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

  3. Imaging Kumar et al

  4. 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

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