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Vertical gaze palsy due to a resolving midbrain lesion.

Meralgia paraesthetica is a common, and usually unilateral mononeuropathy1' characterised by a particularly unpleasant pain in the anterior and lateral aspect ofthe thigh, in the territory of the lateral cutaneous nerve of the thigh. Rarely can the cause of the condition be identified. We have seen four patients with meralgia paraesthetica that could be attributed to their work, when it was necessary for them to support heavy bundles on the anterior and superior aspect of the right thigh. The first case was a healthy 44 year old male. His symptoms began seven months earlier with burning pain in the anterior and lateral aspect of the right thigh. From the age of 13 years he had worked as a sidewalk salesman, carrying large heavy trays which he supported on the anterior superior part ofthe right thigh. Examination revealed hypoaesthesia in the territory corresponding to the right lateral cutaneous nerve ofthe thigh. Palpation of the right iliac crest triggered dysaesthesia in this region. Once the patient stopped supporting weight on this thigh his symptoms improved. The second patient was a 55 year old mason. He complained of a disagreeable "pinprick" numbness of the anterolateral aspect of the right thigh that began a year earlier. He had a history ofmore than 30 years of loading and unloading heavy sacks catching them on the anterior face ofthe right thigh as they were dropped from the truck. Physical examination revealed hypoaesthesia with hyperpathia on the anterior and lateral face of the right thigh and Tinel's sign at the level of the anterosuperior iliac spine. The condition improved when he discontinued work. The third case was a 45 year old male. This mason usually lifted 50 kg bags of cement from the floor to the anterior face of the right thigh and then shifted them to their destination. At 38 years he experienced dysaesthesia of the anterolateral face of the right thigh. Palpation of the anterosuperior iliac spine generated "pinpricks" in the territory innervated by the right femoral cutaneous nerve, which also evidenced hypalgesia. The patient continues his employment and his symptoms persist. The last case was a 45 year old male. Part of his work consisted of supporting the edge of large sheets of metallised plastic on the right groin. A few weeks after beginning his work he complained of sharp "electrical" pains, which extended to the lateral aspect of the right thigh. Physical examination confirmed painful hypoaesthesia of the region and Tinel's sign could be elicited at the level of the anterosuperior iliac spine. Changing his work alleviated the symptoms. The quality and distribution of the pain, the presence of Tinel's sign, the absence of motor deficits or reflex abnormalities, and the normal results of the complementary tests characterise our patients as typical cases of meralgia paraesthetica. Our patients did not have diabetes or significant obesity, which have been described as responsible for some cases.3 Although our patients could have been categorised as idiopathic, their working conditions suggest a traumatic origin. In all four cases the right lateral cutaneous nerve of the thigh was compressed by repeated blows to the groin, where the nerve leaves the abdominal cavity. Discontinuing this activity can alleviate symptoms. We therefore suggest that patients should be asked about their occupational history. E GARCIA-ALBEA F PALOMO J TEJEIRO F CABRERA Neurology Section, Hospital de Alcala de Henares, Ctra Alcald-Meco, Alcald de Henares, 28880 Madrid, Spain