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Teaching NeuroImages 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. 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 digitorum longus, tibialis anterior and medial gastrocnemius Weekly infusions of intravenous methylprednisolone led to improvement in her symptoms. Kumar et al

Imaging Kumar et al

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 mechanisms 1, 2. This case illustrates the value of radiological imaging in recognizing this entity. Kumar et al