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SHORT REPORT
ABSTRACT: We present three patients with signs and symptoms of meralgia paresthetica (MP) after long-distance walking and cycling. No other
possible causes of MP, such as trauma or exogenous compression, were
present. A neuropathy of the lateral femoral cutaneous nerve was confirmed
in all patients with somatosensory evoked potentials. We propose that
conduction block due to local ischemia during repetitive muscle stretching
was the probable cause for the neuropathy.
Muscle Nerve 31: 761–763, 2005
MERALGIA PARESTHETICA AFTER
STRENUOUS EXERCISE
KUAN H. KHO, MD,1 PAUL J. BLIJHAM, MD,2 and MACHIEL J. ZWARTS, MD, PhD2
1
Rudolf Magnus Institute of Neuroscience, Department of Neurology and Neurosurgery,
University Medical Centre, Utrecht, The Netherlands
2
Department of Clinical Neurophysiology, Institute of Neurology, University Medical Centre,
P.O. Box 9101, Nijmegen NL-6500HB, The Netherlands
Accepted 15 November 2004
Meralgia paresthetica (MP) is a sensory mononeuropathy of the lateral femoral cutaneous nerve
(LFCN) that is characterized by abnormal sensation
over the lateral thigh.8 It is often idiopathic. Among
the known causes are those associated with weight
changes or trauma in the pelvic or lower spine area,
and iatrogenic complications of obstetric or orthopedic surgery.3,7 Herein we report three healthy,
nonobese patients with MP after strenuous exercise.
CASE REPORTS
Patient 1 (male, 25 years old, body mass index of
19.6) walked the annual Nijmegen Four Days
Marches, which consist of 4 consecutive days of a
50-km walk (a total of 200 km). He did not train for
this event, and wore loose sports clothing. Symptoms
started with unilateral numbness in the right anterolateral aspect of the thigh after the third day of
marches. His symptoms continued for about a week,
and were followed by gradual sensory recovery accompanied by paresthesias in the same area. There
were no motor symptoms. Clinical examination at
the time of the neurological deficit revealed loss of
sensation on the anterolateral side of the right thigh,
Abbreviations: LFCN, lateral femoral cutaneous nerve; MP, meralgia paresthetica; SSEP, somatosensory evoked potential
Key words: lateral femoral cutaneous nerve; marching; meralgia paresthetica; sensory evoked potentials
Correspondence to: M. J. Zwarts; e-mail: [email protected]
© 2005 Wiley Periodicals, Inc.
Published online 14 January 2005 in Wiley InterScience (www.interscience.
wiley.com). DOI 10.1002/mus.20271
Short Reports
consistent with the sensory area supplied by LFCN.
No other signs were found. On previous participations in the walking event, the patient had developed
similar complaints of anesthesia/paresthesia but did
not seek medical attention. Somatosensory evoked
potentials (SSEPs) were recorded using an established protocol.11 The skin areas of the LFCN and
the ilioinguinal nerve, as well as the dermatomal
areas of L-3 and L-4, were stimulated on both sides,
using surface electrodes placed in the center of each
specific region. The SSEP of the ipsilateral LFCN
showed a prolonged latency and a reduced amplitude as compared with the contralateral side. The
ilioinguinal SSEPs were of normal latencies and amplitudes (Fig. 1A and B).
Patient 2 (male, 52 years old, body mass index of
24.2) also participated in the Four Days Marches.
This patient had no relevant medical history and
trained for the walking event, which he undertook
for the first time. He developed symptoms of numbness and paresthesias on the lateral side of his right
leg during the event. There were no motor symptoms. He consulted us a few weeks later. The diagnosis of MP was considered, with a sensory deficit
being found in the LFCN area, without further abnormalities on neurological examination. No SSEPs
could be recorded after stimulation of the right
LFCN, whereas normal responses were found on the
left side. Recovery was gradual but complete within a
few months.
Patient 3 (male, 49 years old, body mass index of
23.2) had climbed several mountain passes in the
Pyrenees on a bicycle. He had trained for bicycling
MUSCLE & NERVE
June 2005
761
FIGURE 1. (A) Normal SSEPs of the left and right ilioinguinal nerve of patient 1. (B) SSEPs of the left and right lateral femoral cutaneous
nerve of patient 1, showing a decreased amplitude (right: 0.44 ␮V; left: 0.88 ␮V) and a prolonged latency (right: 54.4 ms; left: 34.4 ms)
on the right side. (C) SSEPs of the left and right lateral cutaneous nerve of patient 3, showing an almost absent response on the right
side.
in the mountains and had undertaken this activity
several times previously. He had developed similar
and reversible complaints of numbness on a previous
occasion. He had not sought medical attention at
the time, and reported complete recovery after several weeks. The present symptoms started after he
had climbed two mountains, when he developed a
painful sensation on the lateral side of the right
thigh, lasting for about 1 week, followed by hypesthesia of the same region. On clinical examination,
there was a sensory deficit in the LFCN area. No
motor signs were present. An extensive electrodiagnostic study was performed, including nerve conduction studies of the femoral, peroneal, posterior tibial, and sural nerves, and needle electromyography
of the muscles of the third, fourth, and fifth lumbar
762
Short Reports
root. These studies were all normal. The ipsilateral
SSEP of the LFCN was abnormal, showing a
markedly reduced amplitude with normal latency
(Fig. 1C).
DISCUSSION
We report three cases of electrophysiologically confirmed neuropathy of the LFCN associated with
strenuous exercise. Next to idiopathic causes of MP,
known associations are with trauma (iatrogenic as
well as non-iatrogenic), external compression (tight
clothing,7 seatbelt), and weight change (pregnancy,
possibly obesity). Patients with anatomical variations