Sciatica or Aneurysm? Knowing how a missed diagnosis could be potentially fatal if not diagnosed accurately could be a deadly mistake! Doctors must not fall for a sciatica diagnosis when a possibly fatal iliac artery aneurysm lies looming and progressing.

Sciatica or Aneurysm

An example is a patient who visited an emergency clinic after a few weeks for a non-painful pulsing mass on the buttock. There was no:

• Trauma
• Injury
• Back pain
• Leg pain
• Prior presentations of pain or sciatica issues

A physical examination found a small pulsing mass on the right buttock. Palpation around the site found no issues with the sensory and motor nerves.

An ultrasound scan of the affected area revealed a developing aneurysm. This was followed by a CT scan of the abdomen along with the pelvis using a contrast dye found the aneurysm developing from the left internal iliac artery. If the mass was not present a doctor could easily diagnose sciatica or persistent sciatic artery. If the iliac artery presents with pulsating lesions is a tip-off that a vascular issue could be impinging on the sciatic nerve. Vascular surgery was discussed with the patient. Surgery was necessary, and the patient underwent sciatic aneurysm repair. The patient was discharged without any complications.

Persistent Sciatic Artery

This is a very rare congenital vascular condition. The sciatic artery runs along the sciatic nerve and functions as the major blood supply to the lower extremities. During human embryo development, the femoral artery begins to form while the sciatic arteries start to return to a less developed state. The process continues until the femoral artery takes over as the major blood supply, with only bits of the sciatic artery left.

Persistent sciatic artery can happen either from the sciatic artery not returning to its original size or during normal development the femoral artery developing properly. Most cases of persistent sciatic artery go unknown and are usually detected from another examination for another ailment. Aneurysms often develop based on the arteries/vessel’s tendency for minor trauma/injury when sitting or some form of pressure is applied on the site. Complications include:

• Thrombosis
• Embolism
• Rupture of the artery
• Ischemia
• Pain in the lower limbs

A vascular surgeon should be consulted. Treatment options include:

• Surgical exclusion of the aneurysm
• Surgical excision of the aneurysm
• Endovascular stenting
• Endovascular coiling

Vascular Conditions In The Leg/s That Can Present As Sciatica

The legs’ blood vessels can get infected, bulged, ruptured, or blocked. This can cause sciatica symptoms, like leg pain, weakness, tingling, and numbness. Severe cases could require medical emergency surgery to save the affected limb.

Acute Limb Ischemia

This condition occurs from a decrease or loss of blood supply to the legs. If there is leg pain, it could feel similar to sciatica pain. However, symptoms can progress rapidly and become severe. That’s when it is not sciatica. Acute limb ischemia present one or more of the following symptoms:

• Pain and/or numbness in the leg while walking and when resting
• Severe pain at night
• Sleep problems
• Pain relief when sitting on a chair with the feet hanging down
• Feet and ankles become swollen
• A pale color and lowered skin temperature over the toes and feet when compared to the legs

Acute limb ischemia can develop from an aneurysm, blood clot, or from the thickening of the vessel walls. Treatment should be prompt in order to preserve leg function. Differentiation diagnosis between vascular and other causes like spinal problems that can cause leg pain. A doctor may perform an Ankle/Brachial Index which is a comparison of blood flow in the arms versus the legs. This can be critical in determining if there is vascular insufficiency.

Acute Compartment Syndrome

This places increased pressure in the muscle tissues of the leg. It can lead to loss of blood supply in and around the affected area. The sciatic nerve can also get compressed from the increased pressure in the buttock, thigh, or leg. The condition can cause pain, numbness, and weakness in the buttock, thigh, and leg. Individuals have also reported an unusual/altered sensation in the web of the great toe. This is similar to sciatica, as well as one or both legs can be affected. Differentiating symptoms include:

• Leg becomes swollen
• Pain and tenderness present when touching the leg
• A pale color and lowered skin temperature over the leg

Acute compartment syndrome is a serious condition that is considered a medical emergency. It is possible for the condition to cause complete dysfunction of the limb if not addressed in time. There are risk factors that increase the chances of developing limb ischemia or compartment syndrome. These are:

• Diabetes
• Heart conditions
• High cholesterol
• Smoking
• History of having the condition can also cause a recurrence. This can be from an injury or poor health.

Kidney stones, renal failure, or cysts in the kidney can also cause back and leg pain. Other symptoms can include blood in the urine or difficulty urinating. Any sign of distressing symptoms that present with sciatica can indicate the need for medical attention. This is to check for the possibility of a serious underlying condition or medical emergency. Medical emergencies that are treated in time can help preserve the tissue/s, restore function, and save an individual’s life.

It is essential for a chiropractor or physical therapist to be familiar with diagnosing in a way that will help identify sciatica or aneurysm in individuals presenting with musculoskeletal issues/problems. Knowledge of these risk factors, understanding how to screen for non-musculoskeletal symptoms, basic competence in palpation, and how to interpret findings will help discover sciatica or aneurysm if it is there and begin timely treatment. And if it is not there then a sciatica treatment plan can be developed before it worsens.

Sciatic Nerve Pain Therapy

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References

1. Javdanfar A, Celentano C. Sciatic artery aneurysm. West J Emerg Med. 2010;11(5):516-517.