J Korean Med Sci.  2023 Jul;38(29):e233. 10.3346/jkms.2023.38.e233.

Injury to the Left Sciatic and Right Common Peroneal Nerves Combined With Multifocal Rhabdomyolysis in a Survivor of the Itaewon Crowd Crush: A Case Report

• Kim Y
• Min K
• Park MW
• Shin HI
• Kim DH

• KMID: 2544947
• DOI: http://doi.org/10.3346/jkms.2023.38.e233

Abstract

We report the case of a 27-year-old survivor of the Halloween crowd crush in Itaewon, Seoul, Korea who was diagnosed with left sciatic neuropathy and right common peroneal neuropathy accompanied by multifocal rhabdomyolysis. The patient presented to the emergency room complaining of pain from her lower back to her whole lower extremities with paraparesis and paresthesia. Her blood test showed the marked elevation of creatine kinase and liver enzymes. Magnetic resonance imaging revealed multifocal signal changes in the abdominalis and pelvic girdle muscles suggestive of rhabdomyolysis. Magnetic resonance neurography demonstrated injury to the left sciatic and right peroneal nerves. Electrophysiologic studies also revealed lesions in the left sciatic and right peroneal nerves. After comprehensive rehabilitation and conservative treatment for three months, her muscle strength improved, and she could walk independently. Although several previous studies have reported peripheral neuropathy in immobilized patients, to the best of our knowledge, no case associated with a crowd crush has been reported. Therefore, we report the case of multifocal neuropathy combined with rhabdomyolysis in a victim of a crowd crush incident with good recovery.

Keyword

Peroneal Neuropathy; Sciatic Neuropathy; Rhabdomyolysis; Crowd Crush

Figure

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  Fig. 1 Magnetic resonance imaging of the pelvis. (A) Swelling of the left sciatic nerve (white arrow) from the sciatic foramen to the proximal thigh compared with the right sciatic nerve on an maximum intensity projection image from a coronal reconstructed three-dimensional-short tau inversion recovery sampling perfection with application optimized contrasts with variable flip-angle image. (B) Increased signal intensity in the bilateral external/internal oblique abdominis (white arrow) and left psoas muscle (asterisk) on an axial T2-weighted image with TSE fat suppression. (C) Diffuse swelling of the left sciatic nerve (white arrowhead) surrounded by diffuse edema and high signal change in the left gluteal muscle (white arrow) compared with only a focal signal change near the ischial tuberosity of the right gluteal muscle (white arrow) on an axial T2-weighted slice with TSE fat suppression. (D) Increased signal intensity in the right pectineus (white arrow) and left quadratus femoris muscles (white arrow).TSE = turbo spin echo.

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  Fig. 2 Magnetic resonance imaging of the knee. (A, B) Swelling with enhancement of the right common peroneal nerve (A, white arrow), which winds around the lateral aspect of the fibular head (asterisk), compared with the left common peroneal nerve (B, white arrow) on an maximum intensity projection image from a coronal-reconstructed three-dimensional short tau inversion recovery sampling perfection with application optimized contrasts with variable flip-angle evolutions image. (C) Ill-defined hyper signal intensity changes in right peroneal-innervated muscles (tibialis anterior, extensor digitorum longus, and peroneal longus) (white arrow heads) compared with no signal change in tibial-innervated muscles on the proton density axial turbo spin echo fat-suppression magnetic resonance image.

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