Neuropatía femoral: hematoma en músculo ilíaco y fractura vertebral lumbar / Femoral neuropathy: haematoma in iliac muscle and a lumbar vertebral fracture

Paciente de 75 años con antecedentes de fibrilación auricular anticoagulada con acenocumarol, que presenta dolor, impotencia funcional e parestesias de extremidad inferior derecha tras caída sobre región sacro-coccigea. En pruebas complementarias se evidencia fractura vertebral L5 y hematoma sobre músculo ilíaco derecho, procediéndose a drenaje quirúrgico, suspensión de acenocumarol, e inicio de apixaban. Tras el tratamiento persiste neuropatía femoral, que ha impedido la completa recuperación funcional. DISCUSIÓN: Neuropatía femoral de posible causa por compresiva por hematoma del iliopsoas o radicular por estenosis de canal lumbar y contacto con raíz L4, observando en ambos casos debilidad de musculatura proximal de extremidad inferior. Sospecha hematoma ante dolor lumbar, masa en flanco o hipovolemia. Manejo controvertido e individualizado en función de la severidad de la sintomatología, desde conservador a drenaje quirúrgico para reducir secuelas y complicaciones hemorrágicas. Apixaban ha mostrado mayor perfil de seguridad. La estabilización de fractura lumbar permitió recuperación funcional parcial

75-year-old patient with a history of acenocumarol anticoagulated atrial fibrillation, which shows pain, functional impotence and right lower limb paresthesias after fall. Studies evidenc evertebral fracture L5 and haematoma on right iliac muscle, proceeding to surgical drainage, suspension of acenocumarol, and onset of apixaban. After treatment persisted femoral neuropathy, which not allowed complete functional recovery. DISCUSSION: Femoral neuropathy as possible cause of compressive hematoma over iliopsoas muscle or secundary to lumbar canal stenosis and contact with L4 root. In both of the misit posible to observe weakness of proximal lower limb musculature. Haematoma was suspected due to lower back pain, flank mass and hypovolemia. Handlingis based on the severity of the symptomatology, from conservative to surgical drainage to reduce sequelae and bleeding complications. Apixaban has shown a higher safety profile. Stabilization of lumbar fracture allowed partial functional recovery

[Femoral neuropathy: Haematoma in iliac muscle and a lumbar vertebral fracture]. / Neuropatía femoral: hematoma en músculo ilíaco y fractura vertebral lumbar.

75-year-old patient with a history of acenocumarol anticoagulated atrial fibrillation, which shows pain, functional impotence and right lower limb paresthesias after fall. Studies evidenc evertebral fracture L5 and haematoma on right iliac muscle, proceeding to surgical drainage, suspension of acenocumarol, and onset of apixaban. After treatment persisted femoral neuropathy, which not allowed complete functional recovery. DISCUSSION: Femoral neuropathy as possible cause of compressive hematoma over iliopsoas muscle or secundary to lumbar canal stenosis and contact with L4 root. In both of the misit posible to observe weakness of proximal lower limb musculature. Haematoma was suspected due to lower back pain, flank mass and hypovolemia. Handlingis based on the severity of the symptomatology, from conservative to surgical drainage to reduce sequelae and bleeding complications. Apixaban has shown a higher safety profile. Stabilization of lumbar fracture allowed partial functional recovery.