|Year : 2016 | Volume
| Issue : 4 | Page : 832-833
Boby Varkey Maramattom1, Jacob Eapen Mathew2
1 Department of Neurology, Aster Medcity, Cheranelloor, Kochi, Kerala, India
2 Department of Neurosurgery, Aster Medcity, Cheranelloor, Kochi, Kerala, India
|Date of Web Publication||5-Jul-2016|
Dr. Boby Varkey Maramattom
Department of Neurology, Aster Medcity, Cheranelloor, Kochi, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Maramattom BV, Mathew JE. Postmyelitis pygalgia. Neurol India 2016;64:832-3
A 34-year-old man presented to us with severe pain along the buttocks on sitting. For the last 3 months, after an episode of conus myelitis, he had not been able to sit down and was forced to be working in a standing posture. The pain also appeared in the supine position and got ameliorated on lying on his sides. On examination, he had a normal buttock shape, urinary incontinence, saddle anesthesia, and 4/5 grade weakness in the hip extensors and abductors with an absent ankle jerk. Magnetic resonance imaging showed focal hyperintense signal changes in the conus medullaris and hyperintensities in bilateral obturator internus muscles and gluteal muscles with severe atrophy of the gluteus maximus. The buttock pain was likely caused by the atrophy of the gluteal muscles as a consequence of which his ischial tuberosity had lost its highly effective cushion. Pelvic screening should be considered when the patients complain of buttock pain after the presence of conus–cauda lesions has been established [Figure 1].
|Figure 1: (a and b) T1-weighted magnetic resonance axial images of the pelvis showing atrophic gluteal muscles and obturator internus muscles;. (c and d) Short tau inversion recovery images showing hyperintense atrophic gluteal muscles and obturator internus muscles. (e) The coronal image through the atrophied gluteal muscles. (f) Sagittal lumbar spine magnetic resonance imaging shows the conus atrophy|
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