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Corrêa DG, de Souza SR, Freddi TDAL, Fonseca APA, Dos Santos RQ, Hygino da Cruz LC. Imaging features of neurosyphilis. J Neuroradiol 2023; 50:241-252. [PMID: 36641134 DOI: 10.1016/j.neurad.2023.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/09/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Abstract
Syphilis is an infectious disease caused by the spirochete Treponema pallidum, subspecies pallidum. Although its incidence has declined after the widespread availability of penicillin, it has recently re-emerged, especially in men who have sex with men and in people living with human immunodeficiency virus (HIV). The neurological manifestations of syphilis, generally known as neurosyphilis, may appear at any time during the infection, including the initial years after the primary infection. Neurosyphilis can be asymptomatic, only with cerebrospinal fluid abnormalities, or symptomatic, characterized by several different clinical syndromes, such as meningitis, gumma, meningovascular, brain parenchyma involvement, meningomyelitis, tabes dorsalis, and peripheral nervous system involvement. However, these syndromes may simulate several other diseases, making the diagnosis often a challenge. In addition, syphilis can also be vertically transmitted from mother to child during pregnancy, leading to neurological manifestations. Neuroimaging is essential to demonstrate abnormal brain or spinal cord findings in patients with neurosyphilis, aiding in the diagnosis, treatment, and follow-up of these patients. This article aims to review the imaging features of neurosyphilis, including the early and late stages of the infection.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ 2640-102, Brazil; Department of Radiology, Federal Fluminense University, Rua Marquês de Paraná, 303, Centro, Niterói, RJ 24070-035, Brazil.
| | - Simone Rachid de Souza
- Department of Pathology, Federal University of Rio de Janeiro, Cidade Universitária da Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, Rio de Janeiro, RJ 21941-617, Brazil
| | | | - Ana Paula Alves Fonseca
- Department of Radiology, UnitedHealth Group, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | - Roberto Queiroz Dos Santos
- Department of Radiology, Hospital dos Servidores do Estado, Rua Sacadura Cabral, 178, Saúde, Rio de Janeiro, RJ 20221-903, Brazil; Department of Radiology, Hospital das Américas, United Health Group, Avenida Jorge Curi, 550, Barra da Tijuca, Rio de Janeiro, RJ 22775-001, Brazil
| | - Luiz Celso Hygino da Cruz
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Avenida das Américas, 4666, 302A, 303, 307, 325, 326, Barra da Tijuca, Rio de Janeiro, RJ 2640-102, Brazil
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Shah R, Jayakumar N, Athar S, Ashwood N. When infection mimics cauda equina syndrome: a cautionary tale. Ann R Coll Surg Engl 2021; 103:e181-e183. [PMID: 34058120 DOI: 10.1308/rcsann.2020.7032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
A 63-year-old man presented to the emergency department with low back pain, perineal and genital numbness, together with bilateral lower limb paraesthesia and urinary retention. He was admitted under the orthopaedic service for investigation of suspected cauda equina syndrome. Magnetic resonance imaging of his spine did not reveal any evidence of cauda equina compression. Magnetic resonance imaging of his brain demonstrated nonspecific multiple hyperintensities in the right frontotemporal and left temporo-occipital regions. Computed tomography of his chest, abdomen, and pelvis did not identify any evidence of malignancy. Cerebrospinal fluid from a lumbar puncture showed a high leucocyte count (predominantly lymphocytes). Viral cerebrospinal fluid polymerase chain reaction was positive for varicella zoster virus. A diagnosis of varicella zoster virus myeloradiculitis (Elsberg syndrome) was established and the patient was treated with intravenous aciclovir. Unfortunately, the patient succumbed to a devastating intracerebral haemorrhage during his inpatient stay, probably due to vasculopathy from the underlying varicella zoster virus infection. This case describes a rare infectious mimic of cauda equina syndrome. Elsberg syndrome is an infectious syndrome characterised by bilateral lumbosacral myeloradiculitis, with varicella zoster virus being a well-recognised aetiological agent. We discuss the relevant literature in detail and identify the key, cautionary lessons learned from this case.
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Affiliation(s)
- R Shah
- Lister Hospital, Stevenage, UK
| | - N Jayakumar
- Queen's Hospital Burton, Burton on Trent, UK
| | - S Athar
- Queen's Hospital Burton, Burton on Trent, UK
| | - N Ashwood
- Queen's Hospital Burton, Burton on Trent, UK
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LoRusso S. Disorders of the Cauda Equina. Continuum (Minneap Minn) 2021; 27:205-224. [PMID: 33522743 DOI: 10.1212/con.0000000000000903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Cauda equina dysfunction (often referred to as cauda equina syndrome) is caused by a diverse group of disorders that affect the lumbosacral nerve roots. It is important to recognize dysfunction of the cauda equina quickly to minimize diagnostic delay and lasting neurologic symptoms. This article describes cauda equina anatomy and the clinical features, differential diagnosis, and management of cauda equina disorders. RECENT FINDINGS The diagnosis of disorders of the cauda equina continues to be a challenge. If a compressive etiology is seen, urgent neurosurgical intervention is recommended. However, many people with clinical features of cauda equina dysfunction will have negative diagnostic studies. If the MRI is negative, it is important to understand the diagnostic evaluation and differential diagnosis so that less common etiologies are not missed. SUMMARY Cauda equina dysfunction most often occurs due to lumbosacral disk herniation. Nondiskogenic causes include vascular, infectious, inflammatory, traumatic, and neoplastic etiologies. Urgent evaluation and surgical intervention are recommended in most cases of compressive cauda equina syndrome. Other types of treatment may also be indicated depending on the etiology.
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Yang SD, Zhang F, Ding WY. Analysis of clinical and neurological outcomes in patients with cauda equina syndrome caused by acute lumbar disc herniation: a retrospective-prospective study. Oncotarget 2017; 8:84204-84209. [PMID: 29137416 PMCID: PMC5663588 DOI: 10.18632/oncotarget.20453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 07/26/2017] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES In this research we analyzed the results of surgical treatment of cauda equina syndrome (CES) caused by acute lumbar disc herniation. We emphasize the early treatment for good neurological recovery. METHODS A retrospective-prospective, non randomized, clinical study was performed between Jan 2010 and Dec 2014. We retrospectively collected medical records of 18 patients who suffered from CES due to acute lumbar disc herniation and followed up them regularly. Visual analogue scale (VAS) score, lumbar JOA score (29 points), RR (recovery rate) and Oswestry disability index (ODI) questionnaire were used to evaluate clinical outcomes. RESULTS All patients were followed up for at least two years. Lumbar disc herniation is located at L2-3 level in 2 cases, L3-4 level in 2 cases, L4-5 level in 9 cases, L5-S1 level in 5 cases. VAS score is 6±2.5 preoperatively and 1.5±1.0 postoperatively at last follow-up (P<0.001). JOA score is 5±3.5 preoperatively, while it is 20±7 postoperatively at last follow-up (P<0.001). RR ≥ 50% was found in 12 cases. ODI is 75%±25% preoperatively, while it becomes 28%±16% postoperatively at last follow-up (P<0.001). It also shows that advanced age (≥45 years) may act as a risk factor for poor RR(<50%), while early operation (duration before surgery, <48 h) proves to be a protective factor. CONCLUSIONS Early operations are mandatory and closely relevant to final outcomes for CES patients. However, elder patients are more likely to have poor clinical effect after surgery.
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Affiliation(s)
- Si-Dong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, PR China
| | - Feng Zhang
- Department of Rehabilitation Medicine, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, PR China
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, PR China
- Hebei Provincial Key Laboratory of Orthopaedic Biomechanics, Shijiazhuang, 050051, PR China
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Cauda Equina Syndrome Due to Vigorous Back Massage With Spinal Manipulation in a Patient With Pre-Existing Lumbar Disc Herniation: A Case Report and Literature Review. Am J Phys Med Rehabil 2017; 97:e23-e26. [PMID: 28796647 DOI: 10.1097/phm.0000000000000809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cauda equina syndrome (CES) resulting from acute lumbar disc herniation due to spinal massage is extremely rare. We present a case of CES caused by the acute worsening of a lumbar disc herniation after a vigorous back massage that included spinal manipulation. After vigorous back massage with spinal manipulation performed by a massage therapist, a 38-yr-old male patient experienced CES with severe numbness in both lower limbs, inability to walk due to weakness of bilateral lower limbs, and incontinence of urine and feces. The magnetic resonance imaging and computer tomography scan results showed that the L4-5 disc herniated down into the spinal canal, extensively compressing the ventral dural sac. The patient was successfully treated with an emergency operation including laminectomy, spinal canal decompression, discectomy, interbody fusion, and pedicle screw fixation. The muscle power in both lower limbs of the patient recovered rapidly to support standing only 1 wk later. Moreover, he regained continence of urine and feces. In conclusion, this case brings us novel knowledge that spinal massage or manipulation may worsen pre-existing disc herniation causing CES, and a timely emergency surgery is necessary and effective for treatment of CES-related symptoms.
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