High sciatic lesion mimicking peroneal neuropathy at the fibular head

We report 4 patients with severe, axon-loss, high sciatic mononeuropathies affecting exclusively the peroneal fibers: a boy with a slowly-growing nerve tumor, a woman with an injection injury, and 2 patients who had undergone proximal femur surgery. Clinically, the findings mimicked those seen with common peroneal neuropathy at the fibular head. The peroneal conduction studies were very low in amplitude/unelicitable. Conversely, the tibial studies and H-responses were normal in all; the sural responses were normal in one while low in amplitude/unelicitable in the remaining three. The biceps femoris, short-head, and all peroneal-innervated muscles showed fibrillations and profound motor unit loss. Conversely, the remaining hamstrings and all tibial-innervated muscles were normal. We conclude that a sciatic lesion can imitate a more distal peroneal lesion. Needle EMG of the biceps femoris, short head, is essential for correct diagnosis.