Sciatica nerve injury after intra muscular injection in CNHU of Cotonou: Clinical and electrophysiological aspects summary

Intramuscular injections of quinine commonly realized in malaria endemic region, occur disability in children by sciatica nerve injury. Objective: To analyze the clinical and electromyographic aspects of sciatica nerve injuries reported between 1999 and 2004 in rehabilitation department of National University Hospital of Cotonou. Method: It is about a retrospective survey aimed to be descriptive on a cohort of 139 children aged from 0 to 15 years, examined after sciatica nerve injury symptomatology by intra gluteal injection. Those children enjoyed clinical and electromyographic exam. Results: About 60% of patients consulted in the first three month. Injury affected peroneal nerve (44%), sciatica trunk (41%) and tibial nerve (15%). Paralysis has especially been observed on peroneal nerve (80%) and paresis on tibial nerve (60%) and sciatica trunk (20%). These motor disorders entailed some limping due to steppage (72%), foot slope (21 %) and occurred disabiliting deformities. Amyotrophy has been observed on 70% of patients. Pain has been recorded on 64,5% of patients. Anaesthesia and hypoesthesia were more frequent on peroneal nerve injury whereas hyperesthesia was on tibial and sciatica trunk. EMG achieved on 41% of patients revealed neurotmesis injury (42%), axonotmesis (24%), axonodemyelinating (21%) and neurapraxic injury (12%). Discussion - conclusion: Motor, sensory and electromyographic disorders generated by sciatica nerve injury by intramuscular injection, dragged a heavy handicap among patients. Rate raised of injury revealed by direct traumatism of the nerve (51%) confers to this pathology a medico legal aspect. Intra rectal use of quinine, but especially the promotion of new efficient drugs against malaria, as preventive measures, should permit to reduce the prevalence of these iatrogenic injuries.