Postoperative rhabdomyolysis: a completely localised and symmetrical phenomenon?

The aim of this case report is to describe an unusual case, where rhabdomyolysis was completely confined to both anterior tibial muscles, with sparing of the posterior compartments (no involvement of gastrocnemii). The patient had undergone a 3 h craniotomy and was weaned from ventilator support on postoperative day 1. All haemodynamic and vital parameters were within normal limits. However, severe pain (8/10 on the visual analogue scale) was felt in lateral-anterior tibial compartments bilaterally; creatine kinase (CK) value was found to be abnormally high. An MRI of both tibial regions was performed, that showed very particular findings. The patient complained of foot drop and pain worsening during standing; he recovered completely within 2 months following the surgery, with serum CK dropping considerably within this period.