Expert: Dr. J. Shawn Leatherman - 10/4/2007

Question
Last week as I was getting dressed for work, I experienced a completely unexpected and sudden loss of muscle control in my right thigh (knee to hip). This was accompanied by severe vertigo. Fortunately I was able to collapse on the bed. My wife suspected a heart attack.
In emergency later that day they tested for stroke and heart related causes; all negative; as was later blood work.
Since that attack, I have experienced periods of complete relief interspersed too frequently with throbbing, pins & needles and severe weakness in that same muscle... sometimes with a burning sensation up to the gluteus and rear pelvic area. All accompanied by severe vertigo which seems to pulse in parallel with the throbbing of the muscle.
Lying horizontally relieves the symptoms, but getting on my feet, especially when going to the bathroom at night,or getting up can bring on the symptoms again. The worrisome debilitation and increasing anxiety is only worsening things.
I am scheduled to see a neurologist in future, and in the meantime deep therapeutic massage has been recommended.
My question is...does this appear to be a form of sciatic problem when the initial 'attack' was so severe... and is the accompanying vertigo a common symptom.

Answer
Dear Colin,

This is not a classic presentation of sciatic nerve involvement.  Sciatica does produce radiating pain down the back of the leg to include the buttocks and thigh, but true sciatica involves the lower portion of the leg as well.  Sciatica can lead to weakness in the musculature of the thigh, but this is normally a progressive weakness over time not sudden and remitting.  Also I am not sure exactly what muscle groups are experiencing the weakness, hamstrings, quadriceps, abductors, adductors, glutes or a combination.  When tested, all of the muscles in each group should be tested for strength against resistance.  This will help to pinpoint the source of the weakness from a neurological standpoint as these muscle all receive information from the nerve roots in the lumbar spine and sacral plexus, but from different nerve roots and peripheral nerves.

Vertigo is not a symptom of sciatica, and has absolutely no anatomical connection to the sciatic nerve.  Common causes of vertigo are inner ear dysfunction, receptor dysfunction in the joints of the upper neck, dysfunction or pathology of the brain, or side effects from medication or chemicals.  

My only thoughts about a causative mechanism is that the spinal cord in the neck could be compressed so that multiple neurological structures are being affected thereby creating what is called a long track sign...this means that lower body functions can be affected at the same time that an upper body system neurological function is disturbed.  This is a long-shot though, and normally would present with such symptoms as arm and leg weakness or pain, not vertigo.  Now conversely, the vertigo could have been brought on by a sudden drop in blood pressure as you arise to go to the bathroom at night, this is called orthostatic hypotension, and is due to a pooling of the blood in the lower extremity when arising from a seated or lying position.  It is usually transient, and lasting only for a few seconds, and could explain your combined symptoms, but again this is a long shot.  Simple blood pressure testing by your physician can rule this out.  Your symptoms are definitely confusing concerning one source of the problem, and it is more likely that there are two separate sources which are concurrent.   

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net