• Elizabeth A Dubil, James M Dahle, and Michael D Owens.
• Department of Emergency Medicine, Portsmouth Naval Medical Center, Portsmouth, Virginia 23708, USA.
• J Emerg Med. 2012 Oct 1;43(4):622-4.

BackgroundPresentations of lower extremity compression palsies are rare and exist only in case reports. The true incidence of emergency department (ED) presentations of bilateral sciatic nerve palsy, "toilet bowl neuropathy," is unknown. The following is a case of a 28-year-old active duty Navy woman who presented to our ED via ambulance with bilateral sciatic nerve palsy from prolonged immobility.ObjectivesThis discussion reviews the historical precedence for the diagnosis and details the work-up and prognosis.Case ReportThe patient presented complaining of bilateral lower extremity swelling, numbness, and an inability to walk after a prolonged, medication-facilitated sleep in an unusual position. She had significant weakness on examination and was admitted for further evaluation and care. Specialized neurologic studies were consistent with bilateral sciatic nerve palsy.ConclusionBilateral sciatic nerve palsy is an uncommon cause of lower extremity weakness. In the ED, other diagnoses such as Guillain-Barré syndrome, cauda equina, disk herniation, and gluteal compartment syndrome should be considered initially. The diagnosis of toilet bowl neuropathy, however, is dependent on obtaining an accurate history. This case report adds another perspective to the literature on sciatic nerve palsy recognition, diagnosis, and prognosis.Published by Elsevier Inc.

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