Pediatric Meralgia Paresthetica Lawrence P. Richer, MD,* Michael I. Shevell, MD, CM,* † John Stewart, MB BS,* ‡ and Chantal Poulin, MD* † Meralgia paresthetica is a focal peripheral neuropathy involving the lateral femoral cutaneous nerve and is rarely observed in pediatric practice. Previous reports have highlighted its occurrence within the context of a regional bony malignancy. We present here three patients less than 18 years of age with idiopathic meralgia paresthetica. © 2002 by Elsevier Science Inc. All rights reserved. Richer LP, Shevell MI, Stewart J, Poulin C. Pediatric meralgia paresthetica. Pediatr Neurol 2002;26:321-323. Introduction Meralgia paresthetica, a lesion of the lateral femoral cutaneous nerve causing lateral thigh sensory distur- bances, is relatively common in adults but has been reported infrequently in children. The underrecognition of this condition by pediatric neurologists or other primary care physicians leads to unnecessary investigations and delays in definitive diagnosis [1]. It has thus far been reported in a series of such children only once in the pediatric literature [1], and there are no case reports series in the pediatric neurology literature. We wish to present three patients less than 18 years of age with meralgia paresthetica. Case Reports Patient 1 A 16-year-old male presented with acute onset of numbness of the left lateral thigh. The day before he was well, and there was no history of antecedent trauma. In the evening, he noted decreased sensation when he touched the left lateral thigh. The symptom was persistent without periods of worsening. No aggravating or alleviating factors were de- scribed. There was no history of lower extremity weakness and no complaints of pain. The past medical history was remarkable for previous fractures of both wrists and a nondisplaced clavicular fracture that had all healed well. The perinatal history was uneventful, and early development and school performance was normal. No one else in the family had similar symptoms or other neurologic disorders, including peripheral or entrapment neuropathy. General physical examination was normal. He had a slim body habitus, and there was no external evidence of trauma. Neurologic examination revealed decreased sensation on the lateral aspect of the left thigh to pinprick, cold temperature, and light touch, but not involving the knee. There was no element of hyperesthesia. The rest of the neurologic examination was normal. Investigations included x-rays of the lumbosacral spine that were normal. Bilateral nerve conduction studies of the lateral femoral cutaneous nerve were interpreted as normal, although a needle electromyography (electromyography) examination was not performed. No specific intervention was prescribed, and on follow-up at 1 year the patient was well. The patient did not return for further re-assessment. Patient 2 A 14-year-old female presented with a 5-year history of recurring numbness and pain of the right lateral thigh lasting less than 10 minutes each. These symptoms were aggravated by long walks and alleviated by flexion of the right hip for 2-3 minutes. In between episodes, she was usually symptom-free, and her activities of daily living were not limited in any way. There was no progression in her symptoms. The past medical history was remarkable for postural kyphoscoliosis attributed to tight hamstrings for which physiotherapy had been prescribed. She was born prematurely at 34 weeks gestation and remained in the neonatal nursery for 5 weeks without any significant complications. Early developmental milestones were normal. There was no family history of similar problems or other neurologic disorders, including peripheral or entrapment neu- ropathy. General physical examination was normal, and she had a slim body habitus. Neurologic examination revealed decreased sensation to light touch and cold temperature on the lateral aspect of the right thigh when compared with the other side, and pinprick was slightly hyperes- thetic in the same distribution. The results of the remainder of the neurologic examination were normal. Palpation over the lateral end of the inguinal ligament near the inferomedial aspect of the anterior iliac spine failed to reproduce her sensory symptoms of numbness and pain. Quantitative temperature sensory testing of both lateral thighs was normal but performed on a day when she had no symptoms. The result of magnetic resonance imaging of the lumbosacral area was also normal. No needle electromyography or nerve conduction studies of the lateral femoral cutaneous nerve were performed. Given the intermittent nature of the symptoms, no specific interventions were suggested. At last follow-up 5 months after the initial assessment, the numbness persisted, and she had experienced two further typical episodes of pain and numbness. Patient 3 A 16-year-old moderately obese female presented with acute onset of intermittent bilateral numbness of the lateral thighs. These episodes From the *Departments of Neurology/Neurosurgery; and the † Department of Pediatrics; McGill University; and the ‡ Division of Pediatric Neurology; Montreal Children’s Hospital; ‡ Montreal Neurological Hospital; Montreal, Que ´bec, Canada. Communications should be addressed to: Dr. Shevell; Room A-514; Montreal Children’s Hospital; 2300 Tupper Street; Montreal, Que ´bec, H3H 1P3, Canada. Received July 10, 2001; accepted November 12, 2001. 321 © 2002 by Elsevier Science Inc. All rights reserved. Richer et al: Meralgia Paresthetica PII S0887-8994(01)0097-6 ● 0887-8994/02/$—see front matter