Abstract
Background: The following paper depicts a rare case of acutely developed urinary retention, sensory and motor disturbances due to the formation of a large hematoma within the piriformis muscle, which caused compression of nerves within the suprapiriforme and infrapiriforme foramen, thus imitating cauda equina syndrome. Although cases of acute lumbosacral plexopathy have been described in literature, our case is the first time both urinary retention as well and sensory and motor disturbances were present.
Observations: Most useful tools in the diagnosis of acute piriformis syndrome are a detailed patient history, MRI of the pelvic region and electrophysiological diagnosis of performed by an experienced electrophysiologist. Due to diligent rehabilitation including physiotherapy and electrostimulation, the patient was able to successfully recover, regardless of acute compression of the sacral plexus for a duration of six days.
Lessons: Clinicians should actively ask about previous pelvic trauma when taking the patient history in similar cases, especially if the patient is anticoagulated. If an MRI of the lumbar spine does not reveal any pathologies, an MRI of the pelvic region should be performed.
In similar cases, it is possible to differentiate between spinal cord, cauda equina and pelvic lesions using electrophysiological studies.