Progressing left-side sciatica revealing a common iliac artery mycotic aneurysm in an elderly patient: A CARE-compliant case report

Abstract

Rationale:Sciatica is usually caused by lumbar spine disease; the incidence of sciatica from extra-spinal causes is noted to be only about 0.09%.Patient concerns:We report a case of a 92-year-old man who came to the neurologist outpatient department due to left buttock pain and numbness that radiated to the left lower leg in the recent 6 months and progressed rapidly over 10 days.Diagnosis:We arranged magnetic resonance imaging for lumbar nerve lesion. Magnetic resonance imaging showed a common iliac artery mycotic aneurysm, at about 6.3cm in diameter, which compressed the psoas muscle, nerve plexus, and vein.Interventions:We used a left-side iliac bifurcation stent graft of 12mm in diameter for aneurysm repair. An internal iliac artery with a stent graft of 10mm x 5cm. An abdomen aortic aneurysm stent was inserted, 1cm beneath the right renal artery from the right side femoral artery.Outcomes:After endovascular repair and 4 weeks of antibiotic treatment, he could walk again, and no sciatica was noted. We repeated computed tomography 5 months after the operation and noted that the size of the iliac artery aneurysm decreased without stent graft migration or extravasation. Our patient recovered from sciatic and left leg weakness; above all, he could walk again.Lessons:We suggest practitioners check for common iliac artery aneurysms in the diagnosis of symptoms mimicking spinal cord origin sciatica, especially in elder patients.