A 22-year-old woman is found in a comatose condition, having lain for an unknown length of time on the tile floor of the courtyard. She is found in possession of cocaine. The patient is transported to the hospital while EMT personnel receive instructions for treatment of drug overdose. During the physical examination the patient's gluteal region shows signs of ischemia. After regaining consciousness, she exhibits paralysis of knee flexion and dorsal and plantar flexion and sensory loss in the limb. What is the most likely diagnosis?

Incapacitation and unconsciousness from use of cocaine and other powerful narcotics have led to numerous cases of the "gluteal crush syndrome." Compression of the gluteal region while supine for extended periods of time can lead to gluteal crush injury, in which the nerves and vessels of the gluteal area are compressed. This can result in loss of gluteal muscles and other soft tissues and sciatic nerve compression. The nerve compression can cause paralysis of knee flexors and muscles of the anterior and lateral compartments of the leg, with sensory loss in the posterior thigh and leg and sensory loss in the foot. Tibial nerve loss would not result in loss of dorsiflex- ion of the foot nor generalized sensory loss. Neither piriformis entrapment nor femoral nerve entrapment is associated with loss of gluteal musculature, nor loss of knee flexion or plantar flexion of the foot, nor do they lead to general sensory loss in the limb.