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Lewis MJ. Electrodiagnostic testing in dogs with disorders of the spinal cord or cauda equina. Vet J 2024; 304:106082. [PMID: 38360137 DOI: 10.1016/j.tvjl.2024.106082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/17/2024]
Abstract
Electrodiagnostic (EDX) testing is uncommonly utilized in dogs other than for investigation of disorders of the neuromuscular system. In dogs with diseases affecting the spinal cord or cauda equina, EDX testing can provide functional data complementary to imaging information that together can guide therapeutic and management approaches. Additionally, in some clinical scenarios, EDX testing prior to advanced imaging is integral to identifying if there is spinal cord or cauda equina involvement and can aid in determining the appropriate diagnostic path. This review will outline EDX testing methods that have been reported in dogs relating to the diagnosis, monitoring or prognosis of various conditions affecting the spinal cord and cauda equina. The various tests will be briefly outlined regarding how they are performed and what information is provided. The main focus will be on clinical applications including highlighting situations where EDX testing is useful for differentiating between neurologic and non-neurologic presentations. Additional ways these EDX techniques could be incorporated in the management of diseases of the spinal cord and cauda equina in dogs will be presented.
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Affiliation(s)
- M J Lewis
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Dr, Raleigh, NC 27607, USA.
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2
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Wawrose RA, Oyekan AA, Tang YM, Chen SR, Chen J, Couch BK, Wang D, Alexander PG, Sowa GA, Vo NV, Lee JY. MicroRNA-29a: a novel target for non-operative management of symptomatic lumbar spinal stenosis. Eur Spine J 2024; 33:892-899. [PMID: 37046075 DOI: 10.1007/s00586-023-07671-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/06/2023] [Accepted: 03/18/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Lumbar spinal stenosis (LSS) is the most common reason for spinal surgery in patients over the age of 65, and there are few effective non-surgical treatments. Therefore, the development of novel treatment or preventative modalities to decrease overall cost and morbidity associated with LSS is an urgent matter. The cause of LSS is multifactorial; however, a significant contributor is ligamentum flavum hypertrophy (LFH) which causes mechanical compression of the cauda equina or nerve roots. We assessed the role of a novel target, microRNA-29a (miR-29a), in LFH and investigated the potential for using miR-29a as a therapeutic means to combat LSS. METHODS Ligamentum flavum (LF) tissue was collected from patients undergoing decompressive surgery for LSS and assessed for levels of miR-29a and pro-fibrotic protein expression. LF cell cultures were then transfected with either miR-29a over-expressor (agonist) or inhibitor (antagonist). The effects of over-expression and under-expression of miR-29a on expression of pro-fibrotic proteins was assessed. RESULTS We demonstrated that LF at stenotic levels had a loss of miR-29a expression. This was associated with greater LF tissue thickness and higher mRNA levels of collagen I and III. We also demonstrated that miR29-a plays a direct role in the regulation of collagen gene expression in ligamentum flavum. Specifically, agents that increase miR-29a may attenuate LFH, while those that decrease miR-29a promote fibrosis and LFH. CONCLUSION This study demonstrates that miR-29a may potentially be used to treat LFH and provides groundwork to initiate the development of a therapeutic product for LSS.
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Affiliation(s)
- Richard A Wawrose
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, 200 Lothrop Street, E1643 Biomedical Science Tower, Pittsburgh, PA, 15261, USA
- Pittsburgh Ortho Spine Research (POSR) Group, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anthony A Oyekan
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, 200 Lothrop Street, E1643 Biomedical Science Tower, Pittsburgh, PA, 15261, USA
- Pittsburgh Ortho Spine Research (POSR) Group, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yunting Melissa Tang
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, 200 Lothrop Street, E1643 Biomedical Science Tower, Pittsburgh, PA, 15261, USA
- Pittsburgh Ortho Spine Research (POSR) Group, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephen R Chen
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, 200 Lothrop Street, E1643 Biomedical Science Tower, Pittsburgh, PA, 15261, USA
- Pittsburgh Ortho Spine Research (POSR) Group, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph Chen
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, 200 Lothrop Street, E1643 Biomedical Science Tower, Pittsburgh, PA, 15261, USA
- Pittsburgh Ortho Spine Research (POSR) Group, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brandon K Couch
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, 200 Lothrop Street, E1643 Biomedical Science Tower, Pittsburgh, PA, 15261, USA
- Pittsburgh Ortho Spine Research (POSR) Group, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dong Wang
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, 200 Lothrop Street, E1643 Biomedical Science Tower, Pittsburgh, PA, 15261, USA
- Pittsburgh Ortho Spine Research (POSR) Group, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter G Alexander
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, 200 Lothrop Street, E1643 Biomedical Science Tower, Pittsburgh, PA, 15261, USA
- Pittsburgh Ortho Spine Research (POSR) Group, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gwendolyn A Sowa
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, 200 Lothrop Street, E1643 Biomedical Science Tower, Pittsburgh, PA, 15261, USA
- Pittsburgh Ortho Spine Research (POSR) Group, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nam V Vo
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, 200 Lothrop Street, E1643 Biomedical Science Tower, Pittsburgh, PA, 15261, USA
- Pittsburgh Ortho Spine Research (POSR) Group, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joon Y Lee
- Ferguson Laboratory for Orthopedic and Spine Research, Department of Orthopedic Surgery, University of Pittsburgh, 200 Lothrop Street, E1643 Biomedical Science Tower, Pittsburgh, PA, 15261, USA.
- Pittsburgh Ortho Spine Research (POSR) Group, Department of Orthopedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Wang Q, Wen M, Hou G, Zhao S, Yao Z, Tu Z, Huang P, Ye B, Xie F, Luo Z, Hu X. Chronic cauda equina syndrome decompression surgery recovery is very "bad"? Based on patient self-assessment. Eur Spine J 2024; 33:932-940. [PMID: 37947889 DOI: 10.1007/s00586-023-07984-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/31/2023] [Accepted: 10/02/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Symptoms of cauda equina syndrome (CES) secondary to degenerative lumbar spine diseases are sometimes mild and tend to be ignored by patients, resulting in delayed treatment. In addition, the long-term efficacy of surgery is unclear. OBJECTIVE To determine the predictive factors of CES and post-operative recovery in patients with symptoms lasting > 3 months. METHODS From January 2011 to December 2020, data of 45 patients with CES secondary to lumbar disk herniation/lumbar spinal stenosis were collected from a single center. The patients had bladder, bowel or sexual dysfunction and decreased perineal sensation that lasted for > 3 months. A 2-year post-operative follow-up was conducted to evaluate recovery outcomes, which were measured by validated self-assessment questionnaires conducted by telephone and online. RESULTS Overall, 45 CES patients (57.8% female; mean age, 56 years) were included. The duration of pre-operative CES symptoms was 79.6 weeks (range, 13-730 weeks). The incidence of saddle anesthesia before decompression was 71.1% (n = 32), bladder dysfunction 84.4% (n = 38), bowel dysfunction 62.2% (n = 28) and sexual dysfunction 64.4% (n = 29). The overall recovery rate of CES after a 2-year follow-up was 64.4%. The rates of the residual symptoms at the last follow-up were as follows: saddle anesthesia 22.2%, bladder dysfunction 33.3%, bowel dysfunction 24.4% and sexual dysfunction 48.9%. Pre-operative saddle anesthesia, overactive bladder and sexual dysfunction were risk factors for poor prognosis after decompression. CONCLUSION CES patients with symptoms lasting > 3 months may recover after surgery. Sexual dysfunction has a high residual rate and should not be ignored during diagnosis and treatment.
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Affiliation(s)
- Qiushi Wang
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Mengyuan Wen
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Guangdong Hou
- Department of Urology, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Shixian Zhao
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zhou Yao
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zhipeng Tu
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Peipei Huang
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Bin Ye
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Fang Xie
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China
| | - Zhuojing Luo
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China.
| | - Xueyu Hu
- Department of Orthopaedic, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China.
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Shankar D, Kaif M, Kumar K. Post-traumatic lumbar nerve root entrapment into the spinous process of the lumbar spine. BMJ Case Rep 2024; 17:e257802. [PMID: 38373811 PMCID: PMC10882333 DOI: 10.1136/bcr-2023-257802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
Thoracolumbar fractures constitute a significant portion of spinal trauma, accounting for 15-20% of the cases. These fractures, caused by high-impact injuries, may involve tears of the posterior ligamentous complex, presenting a high chance of neurological injury ranging from dural tears to spinal root avulsion. This case report discusses a rare occurrence of avulsion of lumbosacral nerve roots posteriorly, becoming entrapped in the fractured spinous process of the L2 lumbar vertebra, leading to cauda equina syndrome following trauma and its implications during surgery.
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Affiliation(s)
- Diwakar Shankar
- Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mohammad Kaif
- Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Krishna Kumar
- Neurosurgery, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Balodis A, Ņeverčika V, Zavertjajeva M, Mikijanskis R, Kalnina M, Breikša-Vaivode A, Briede I. Giant Myxopapillary Ependymoma with Multi-Site Neural Axis Metastases: A Rare Case with Suboptimal Outcome. Am J Case Rep 2024; 25:e942392. [PMID: 38291726 PMCID: PMC10846752 DOI: 10.12659/ajcr.942392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/22/2023] [Accepted: 11/28/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Myxopapillary ependymoma is a rare type of slow-growing tumor that mainly occurs in the spinal cord, particularly in the region of the conus medullaris and the cauda equina. It originates from the ependymal glial cells found in the filum terminale. CASE REPORT We present a clinical case of a 44-year-old male patient who presented with symptoms of non-specific pain in the lower back persisting for the past 2 years. He did not report any specific neurological deficits or radicular symptoms. Unenhanced MRI of the lumbar spine showed a giant intradural, extramedullary, heterogenous, expansive tumor at the level L1-S4 with erosion of the sacral bone and invasion of presacral tissue. Based on its characteristic localization and growth pattern, suspicion arose for myxopapillary ependymoma. Biopsy confirmed the initial diagnosis. Partial resection of the tumor with laminectomy and laminoplasty was deemed necessary. Preoperative neural axis MRI showed contrast-enhancing lesions in the cerebellum and the cervical and thoracic spine; therefore, adjuvant radiation therapy was administered. Following the surgery, the patient experienced intermittent episodes of neurological deficits and required physiotherapy. Control MRI a year after the operation showed tumor growth and more metastases along the neural axis. CONCLUSIONS Complete surgical excision of the tumor is the preferred treatment approach, but there is a risk of recurrence even after total excision, so radiotherapy is recommended to minimize the risk of recurrence. Prior to surgery, it is essential to conduct MRI/PET/CT of the head and spine to assess the possibility of metastases.
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Affiliation(s)
- Arturs Balodis
- Institute of Diagnostic Radiology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Department of Radiology, Riga Stradiņš University, Riga, Latvia
| | | | - Marija Zavertjajeva
- Institute of Diagnostic Radiology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Department of Radiology, University of Latvia, Riga, Latvia
| | - Raimonds Mikijanskis
- Department of Neurosurgery, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | | | | | - Inese Briede
- Department of Pathology, Riga Stradiņš University Hospital, Riga, Latvia
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Ni H, Zheng Y, Lu S, Jia Z, Shi H, Liu S, Zhao L. Aneurysmal subarachnoid hemorrhage complicating spinal subarachnoid hematoma causing acute cauda equina syndrome: a case report. BMC Neurol 2024; 24:5. [PMID: 38166773 PMCID: PMC10759738 DOI: 10.1186/s12883-023-03404-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/26/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Spinal subarachnoid hematoma (SSH) is a known but rare entity that can cause cauda equina compression. The occurrence of SSH associated with aneurysmal subarachnoid hemorrhage has rarely been described in the literature. CASE PRESENTATION A 56-year-old woman presented with subarachnoid hemorrhage secondary to a ruptured middle cerebral artery aneurysm and was managed with coiling embolization without stent assistance. There was no history of either lumbar puncture or the use of anticoagulants. The patient developed severe lumbago radiating to bilateral legs nine days after the procedure. Subsequent magnetic resonance imaging demonstrated a SSH extending from L5 to S2 and wrapping around the cauda equina. The patient was treated with intravenous methylprednisolone (250 mg/day) for four consecutive days, followed by a taper of oral prednisolone (20 mg/day) until complete recovery. Magnetic resonance imaging at one month follow-up revealed complete resolution of the SSH. CONCLUSIONS Here, we report a case of acute cauda equina syndrome caused by a SSH after aneurysmal subarachnoid hemorrhage, which will facilitate timely intervention of patients with this disorder.
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Affiliation(s)
- Heng Ni
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, 210029, Nanjing, China
| | - Yu Zheng
- Department of Radiology, The Affiliated YiXing Hospital of Jiangsu University, 75 Tongzhenguan Rd, 214200, Wuxi, China
| | - Shanshan Lu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, 210029, Nanjing, China
| | - Zhenyu Jia
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, 210029, Nanjing, China
| | - Haibin Shi
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, 210029, Nanjing, China
| | - Sheng Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, 210029, Nanjing, China
| | - Linbo Zhao
- Department of Interventional Radiology, The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, 210029, Nanjing, Jiangsu Province, China.
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Joo S, Kim CR, Kim S. Association of Tarlov cyst with cauda equina syndrome and spinal cord infarction following caudal epidural block: A case report. Medicine (Baltimore) 2023; 102:e35824. [PMID: 37986362 PMCID: PMC10659614 DOI: 10.1097/md.0000000000035824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/06/2023] [Indexed: 11/22/2023] Open
Abstract
RATIONALE Caudal epidural block (CEB), which injects drugs into the epidural space through a sacral hiatus, is considered a safer alternative to other approaches. Serious complications, such as cauda equina syndrome or spinal cord infarction, have been reported very rarely, but their coexistence after CEB, which may be related to the ruptured perineural cyst, also known as a Tarlov cyst, was not reported. PATIENT CONCERNS A 40-year-old male patient presented with bilateral lower extremity radicular pain. CEB was performed without image guidance. The patient exhibited sensory deficits below L2, no motor function (0-grade), hypotonic deep tendon reflexes, and no pathological reflexes. DIAGNOSES Spinal cord infarction, cauda equina syndrome, and sacral level perineural cyst with hemorrhage. INTERVENTION High doses of steroids and rehabilitation were performed. OUTCOMES The patient was discharged after 28 days with persistent bilateral leg paralysis and sensory deficits below the L2 level. The patient demonstrated no neurological improvement. LESSONS Magnetic resonance imaging, including the sacral area, should be performed before performing CEB, to confirm the presence of a perineural cyst.
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Affiliation(s)
- Sunyoung Joo
- Department of Rehabilitation Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Jeonha 1(IL)-dong, Dong-gu, Ulsan, Korea
| | - Chung Reen Kim
- Department of Rehabilitation Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Jeonha 1(IL)-dong, Dong-gu, Ulsan, Korea
| | - Sunyoung Kim
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Jeonha 1(IL)-dong, Dong-gu, Ulsan, Korea
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Metcalfe D, Hoeritzauer I, Angus M, Novak A, Hutton M, Woodfield J. Diagnosis of cauda equina syndrome in the emergency department. Emerg Med J 2023; 40:787-793. [PMID: 37669831 DOI: 10.1136/emermed-2023-213151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023]
Abstract
Cauda equina syndrome (CES) is a spinal emergency that can be challenging to identify from among the many patients presenting to EDs with low back and/or radicular leg pain. This article presents a practical guide to the assessment and early management of patients with suspected CES as well as an up-to-date review of the most important studies in this area that should inform clinical practice in the ED.
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Affiliation(s)
- David Metcalfe
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Emergency Medicine Research in Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Michelle Angus
- Complex Spinal Department, Salford Royal NHS Foundation Trust, Salford, UK
| | - Alex Novak
- Emergency Medicine Research in Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mike Hutton
- Exeter Spinal Surgery Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Fraig H, Gibbs DMR, Lloyd-Jones G, Evans NR, Barham GS, Dabke HV. Early experience of a local pathway on the waiting time for MRI in patients presenting to a UK district general hospital with suspected cauda equina syndrome. Br J Neurosurg 2023; 37:1094-1100. [PMID: 35232306 DOI: 10.1080/02688697.2022.2039377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 02/02/2022] [Indexed: 11/02/2022]
Abstract
AIM This study evaluated the impact of the Salisbury Protocol for Assessment of Cauda Equina Syndrome (SPACES) on the waiting time for MRI in patients presenting with suspected Cauda Equina Syndrome (sCES) within a UK district general hospital. PATIENTS AND METHODS All consecutive patients undergoing an MRI scan in our hospital, for sCES, over a 12 month period, prior to and following the introduction of SPACES, were identified. Patient's gender, age, MRI diagnosis, time from MRI request to imaging and outcome were recorded. RESULTS In the year prior to the introduction of SPACES, 66 patients underwent MRI for sCES, out of which 10.6% had cauda equina compression (CEC), 63.5% had other spinal pathology and 25% had a normal scan. In the year after introduction of SPACES, 160 patients underwent MRI for sCES out of which 6.2% had CEC, 70.7% had other spinal pathology and 23% had a normal scan. Despite the referrals for sCES increasing by more than 2-fold following the introduction of SPACES, the median time from MRI request to scan decreased from 9.1 to 4.2 hours (p = 0.106, Mann-Whitney-U) and the number of patients transferred to the regional hub hospital decreased from 7 to 3. CONCLUSION Implementation of SPACES for patients with sCES resulted in a substantial reduction in waiting time for MRI and decreased the number of transfers to the regional hub hospital. Based on our early experience, we encourage other centres within the UK to introduce such a pathway locally, to improve the management of patients with sCES.
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Affiliation(s)
- H Fraig
- Specialty Registrar Trauma & Orthopaedic Surgery, Salisbury District Hospital, Salisbury, UK
| | - D M R Gibbs
- Trust Grade Trauma & Orthopaedic Surgeon, Salisbury District Hospital, Salisbury, UK
| | - G Lloyd-Jones
- Consultant Radiologist, Salisbury District Hospital, Salisbury, UK
| | - N R Evans
- Consultant Spinal and Trauma Surgeon, Salisbury District Hospital, Salisbury, UK
| | - G S Barham
- Consultant Spinal and Trauma Surgeon, Salisbury District Hospital, Salisbury, UK
| | - H V Dabke
- Consultant Spinal and Trauma Surgeon, Salisbury District Hospital, Salisbury, UK
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Djurhuus JC, Olsen LH. Editorial commentary to clinical utility and interrater reliability of video urodynamics in children with isolated fibrolipoma of filum terminale. J Pediatr Urol 2023; 19:532-533. [PMID: 37422428 DOI: 10.1016/j.jpurol.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 07/10/2023]
Affiliation(s)
| | - L Henning Olsen
- Department Clinical Medicine, Aarhus University, Aarhus, Denmark.
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Xu J, Zhao T, Wu W, Yang X, Wu Y, Lou J, Shao T, Zhang J. In Reply to the Letter to the Editor Regarding "Publication Trends and Hot Spots in Cauda Equina Syndrome: A Bibliometric Analysis and Visualization of Current Research". World Neurosurg 2023; 178:290. [PMID: 37803678 DOI: 10.1016/j.wneu.2023.07.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Jiongnan Xu
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou Medical College People's Hospital, Hangzhou, Zhejiang, China; The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Tinxiao Zhao
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou Medical College People's Hospital, Hangzhou, Zhejiang, China
| | - Weiyi Wu
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou Medical College People's Hospital, Hangzhou, Zhejiang, China; The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xinwen Yang
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou Medical College People's Hospital, Hangzhou, Zhejiang, China; Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yufeng Wu
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou Medical College People's Hospital, Hangzhou, Zhejiang, China; Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jianfen Lou
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou Medical College People's Hospital, Hangzhou, Zhejiang, China
| | - Ting Shao
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou Medical College People's Hospital, Hangzhou, Zhejiang, China
| | - Jun Zhang
- Department of Orthopedics, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, Guizhou, China.
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Batie SF, Coco CT, Braga BP, Chan YY, Stanasel I, Jacobs MA, Baker LA, Peters CA, Schlomer BJ. Clinical utility and interrater reliability of video urodynamics in children with isolated fibrolipoma of filum terminale. J Pediatr Urol 2023; 19:524-531. [PMID: 37211501 DOI: 10.1016/j.jpurol.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/19/2023] [Accepted: 05/03/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Children with an isolated fibrolipoma of filum terminale (IFFT) but otherwise normal spinal cord are often evaluated with video urodynamics (VUDS). VUDS interpretation is subjective and can be difficult in young children. These patients may undergo detethering surgery if there is concern for current or future symptomatic tethered cord. OBJECTIVE We hypothesized that VUDS in children with IFFT would have limited clinical utility regarding decision for or against detethering surgery and VUDS interpretation would have poor interrater reliability. METHODS Patients with IFFT who underwent VUDS for from 2009 to 2021 were retrospectively reviewed to evaluate clinical utility of VUDS. 6 pediatric urologists who were blinded to patient clinical characteristics reviewed the VUDS. Gwet's first order agreement coefficient (AC1) with 95% CI was used to assess interrater reliability. RESULTS 47 patients (24F:23M) were identified. Median age at initial evaluation was 2.8yrs (IQR:1.5-6.8). 24 (51%) patients underwent detethering surgery (Table). VUDS at initial evaluation were interpreted by treating urologist as normal in 4 (8%), reassuring for normal in 39 (81%), or concerning for abnormal in 4 (9%). Based on neurosurgery clinic and operative notes for the 47 patients, VUDS made no change in management in 37 patients (79%), prompted detethering in 3 (6%), was given as reason for observation in 7 (15%), and was normal or reassuring for normal but not documented as a reason for observation in 16 (34%) (Table). Interrater reliability for VUDS interpretation had fair agreement (AC1 = 0.27) for overall categorization of VUDS and EMG interpretation (AC1 = 0.34). Moderate agreement was seen for detrusor overactivity interpretation (AC1 = 0.54) and bladder neck appearance (AC1 = 0.46). DISCUSSION In our cohort, 90% of patients had a normal or reassuring for normal interpretation of VUDS. VUDS interpretation affected clinical course in a minority of patients. There was fair interrater reliability for overall VUDS interpretation and therefore clinical course regarding detethering surgery could vary depending upon interpreting urologist. This fair interrater variability appeared to be related to variability in EMG, bladder neck appearance, and detrusor overactivity interpretation. CONCLUSION VUDS affected clinical management in about 20% of our cohort and supported the choice for observation in around 50% of patients. This suggests VUDS does have clinical utility in pediatric patients with IFFT. The overall VUDS interpretation had fair interrater reliability. This suggest VUDS interpretation has limitations in determining normal versus abnormal bladder function in children with IFFT. Neurosurgeons and urologists should be aware of VUDS limitations in this patient population.
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Affiliation(s)
- Shane F Batie
- Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Caitlin T Coco
- Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bruno P Braga
- Division of Pediatric Neurosurgery, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yvonne Y Chan
- Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Irina Stanasel
- Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Micah A Jacobs
- Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Craig A Peters
- Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Bruce J Schlomer
- Division of Pediatric Urology, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Woodfield J, Statham PFX, Hoeritzauer I. Letter to the Editor Regarding Publication Trends and Hot Spots in Cauda Equina Syndrome: A Bibliometric Analysis and Visualization of Current Research. World Neurosurg 2023; 178:289. [PMID: 37803677 DOI: 10.1016/j.wneu.2023.06.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
| | | | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK; Department of Clinical Neurosciences, NHS Lothian, Edinburgh, Scotland, UK
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14
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Guo H, Villaluz J. Delayed approach to postdural puncture headache. BMJ Case Rep 2023; 16:e254018. [PMID: 37739443 PMCID: PMC10533738 DOI: 10.1136/bcr-2022-254018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 09/24/2023] Open
Abstract
A postpartum female in her mid-20s presented with atypical symptoms of postdural puncture headache. However, on initial presentation, the patient reported no headache. Primary symptoms of acute, severe interscapular pain and upper extremity radiculopathy at the time of epidural placement were observed. The absence of a positional headache and the severity of pain at presentation prompted MRI analysis to establish a clinical diagnosis.MRI findings revealed a significant cerebrospinal fluid (CSF) leak causing a mass effect on the cervicothoracic spinal cord and severe stenosis at the cauda equina. An epidural blood patch (EBP) was considered; however, it was postulated that the narrow epidural space would not be sufficient to accommodate the volume associated with an EBP. She was managed conservatively until subsequent imaging revealed CSF resorption. She received an epidural blood patch on day 7. Thereafter, her symptoms improved, allowing her to nurse her infant and be discharged home.
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Affiliation(s)
- Haiyan Guo
- Department of Anesthesiology, Kaweah Delta Health Care District, Visalia, California, USA
| | - Joseph Villaluz
- Department of Anesthesiology, Kaweah Delta Health Care District, Visalia, California, USA
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15
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Byvaltsev VA, Kalinin AA, Shepelev VV, Pestryakov YY, Satardinova EE, Goloborodko VY, Khozeev DV. [Long-term results and predictors of postoperative outcomes in patients with cauda equina syndrome following degenerative lumbar spine disease]. Zh Vopr Neirokhir Im N N Burdenko 2023; 87:35-43. [PMID: 36763551 DOI: 10.17116/neiro20238701135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Cauda equina syndrome (CES) associated with acute disc extrusion or spinal stenosis often requires emergency surgery. Analysis of the Pubmed, Medline and eLibrary databases revealed a few studies devoted to long-term postoperative outcomes in patients with CES caused by degenerative spine disease. OBJECTIVE To evaluate long-term postoperative results and predictors of clinical and neurological outcomes in patients with CES caused by degenerative lumbar spine disease. MATERIAL AND METHODS. D Ecompressive and decompressive-stabilizing procedures were performed in 211 patients with CES caused by degenerative lumbar spine disease between 2000 and 2020. Long-term clinical parameters were available in 174 patients with mean follow-up period of 7 years. Sixty-eight patients had unsatisfactory postoperative outcomes. We assessed postoperative clinical and neurological outcomes in patients with CES and predictors of these outcomes. RESULTS We identified the following predictors of clinical and neurological outcomes using binary logistic regression model: period between clinical manifestation and surgery >48 hours, preoperative neurological impairment, spinal canal diameter, surgical procedure, dimension of herniated disc, ASA score and long-term postoperative analgesia with narcotic analgesics. CONCLUSION Preoperative planning and possible correction of the above-mentioned risk factors will potentially improve postoperative outcomes in patients with CES caused by degenerative lumbar spine disease.
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Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University, Irkutsk, Russia
- Russian Railways-Medicine Clinical Hospital, Irkutsk, Russia
- Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia
- Russian Railways-Medicine Clinical Hospital, Irkutsk, Russia
| | - V V Shepelev
- Irkutsk State Medical University, Irkutsk, Russia
| | | | - E E Satardinova
- Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | | | - D V Khozeev
- Irkutsk State Medical University, Irkutsk, Russia
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16
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Kim M, Kim H. Cauda equina syndrome by extrusion of lumbar disc after lumbar sympathetic neurolysis. Neurosciences (Riyadh) 2023; 28:53-56. [PMID: 36617447 PMCID: PMC9987630 DOI: 10.17712/nsj.2023.1.20220055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/12/2022] [Indexed: 01/09/2023]
Abstract
A 56-year-old woman experienced persistent excruciating pain with peroneal nerve injury in the anterior aspect of the lower leg after knee surgery. In our pain clinic, we diagnosed the patient with complex regional pain syndrome and performed lumbar sympathetic neurolysis (LSN) with absolute alcohol at the 3rd lumbar vertebra (L3). After the next follow-up, she complained of continuous dull low back pain, anal dysregulation, and fecal incontinence. We performed magnetic resonance imaging (MRI) to rule out other existing pathologies of back pain. On MRI, the nucleus pulposus was moderately extruded to the central zone with inferior sequestration at L2/3, and moderate central canal stenosis was observed at L2/3. She underwent partial laminectomy with discectomy at L2 level. We were not sure of the cause of disc herniation, but we strongly suspected that LSN at the L3 vertebral level was related to the pathology. Therefore, we discuss this unusual case.
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Affiliation(s)
- Minhyun Kim
- From the Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Hyuckgoo Kim
- From the Department of Anesthesiology and Pain Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Hadidi O, Hijazi H, Pajda R, Bayer T. Spinal epidural lipomatosis and focal posterior longitudinal ligament hypertrophy causing severe cauda equina crowding. BMJ Case Rep 2022; 15:e250112. [PMID: 36180104 PMCID: PMC9528478 DOI: 10.1136/bcr-2022-250112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Omar Hadidi
- Trauma & Orthopaedic Surgery, Midland Regional Hospital Tullamore, Tullamore, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Humayun Hijazi
- Trauma & Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
| | - Rafal Pajda
- Trauma & Orthopaedic Surgery, Midland Regional Hospital Tullamore, Tullamore, Ireland
| | - Thomas Bayer
- Trauma & Orthopaedics, Midland Regional Hospital Tullamore, Tullamore, Ireland
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18
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Tabrah J, Wilson N, Phillips D, Böhning D. Can digital rectal examination be used to detect cauda equina compression in people presenting with acute cauda equina syndrome? A systematic review and meta-analysis of diagnostic test accuracy studies. Musculoskelet Sci Pract 2022; 58:102523. [PMID: 35180641 DOI: 10.1016/j.msksp.2022.102523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Digital rectal examination (DRE) is a commonly used test to help identify people with cauda equina compression (CEC). OBJECTIVE To determine the diagnostic accuracy of DRE in assessment of anal tone, squeeze, sensation and reflexes, as predictors of CEC. DESIGN A systematic review to investigate the diagnostic accuracy of DRE to detect CEC compared with lumbar Magnetic Resonance Imaging (MRI). METHOD Six electronic databases were searched from inception to 6 July 2020 for studies published in English. Two assessors independently performed screening, data extraction and risk of bias assessment (QUADAS-2). Meta-analysis was performed using STATA-16. RESULTS Six studies were included (n = 741). The sensitivity of anal tone was low across all studies (range: 0.23 to 0.53) with moderate quality evidence against the use of DRE of anal tone. One study on anal sensation found no correlation with CEC using Kendall's tau test: p = 0.102 and another found sensation had low test accuracy. One study identified sensitivity: 0.29 and specificity: 0.96 for anal squeeze, while another identified sensitivity: 0.38 and specificity: 0.6 for anal reflexes. CONCLUSION The diagnostic accuracy of DRE of anal tone to detect CEC is low and carries a high risk of false reassurance. It is therefore not recommended in any clinical setting. More research is needed to determine the diagnostic accuracy of DRE of anal squeeze, sensation and reflexes and if done the results should be interpreted with caution.
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Affiliation(s)
- Julia Tabrah
- Hounslow and Richmond Community Healthcare NHS Trust. Therapies Centre (O-Block), West Middlesex Hospital, Twickenham Road, Isleworth, TW7 6AF, UK.
| | - Nicky Wilson
- Kings College Hospital NHS Foundation Trust, UK.
| | - Dean Phillips
- School of Health Sciences, University of Southampton, UK.
| | - Dankmar Böhning
- School of Mathematical Sciences and Southampton Statistical Sciences Research Institute, University of Southampton, UK.
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Ward TRW, Garala K, Dos Remedios I, Lim J. Piriformis syndrome as a result of intramuscular haematoma mimicking cauda equina effectively treated with piriformis tendon release. BMJ Case Rep 2022; 15:e247988. [PMID: 35236695 PMCID: PMC8895925 DOI: 10.1136/bcr-2021-247988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 11/04/2022] Open
Abstract
We present a case of piriformis syndrome in a woman in her 30's following low energy trauma, presenting with unilateral lower limb weakness, altered sensation and urinary retention. CT imaging revealed a bulky piriformis muscle which was further clarified on MRI as an intramuscular haematoma within the left piriformis causing compression of the left lumbosacral plexus. Haematoma formation was exacerbated due to use of an antiplatelet medication the patient was taking for Moyamoya disease, which carries an increased risk of cerebrovascular accident. Surgical exploration of the piriformis and sciatic nerve was undertaken and confirmed a haematoma within the piriformis. A full release of the piriformis tendon was undertaken, and the sciatic nerve was inspected, no further abnormality was found. After review in clinic post-discharge, the patient reported normal sensation and normal muscle power in her feet.
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Affiliation(s)
- Thomas Robert William Ward
- Trauma and Orthopaedics, Department of Orthopaedics, Royal Stoke University Hospital, Stoke-on-trent, UK
| | - Kanai Garala
- Trauma and Orthopaedics, Department of Orthopaedics, Royal Stoke University Hospital, Stoke-on-trent, UK
| | - Ian Dos Remedios
- Trauma and Orthopaedics, Department of Orthopaedics, Royal Stoke University Hospital, Stoke-on-trent, UK
| | - Justin Lim
- Trauma and Orthopaedics, Department of Orthopaedics, Royal Stoke University Hospital, Stoke-on-trent, UK
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20
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Rascón-Ramírez FJ. Spinal cord stimulation and cauda equina syndrome: Could it be a valid option? A report of two cases. Neurocirugia (Astur : Engl Ed) 2022; 33:90-94. [PMID: 35248303 DOI: 10.1016/j.neucie.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/16/2020] [Indexed: 06/14/2023]
Abstract
Spinal cord stimulation (SCS) consists of the application of electrical stimuli to the dorsal columns of the spinal cord or to the posterior nerve roots in order to modulate the pain signals carried by the ascending pain pathways to the brain. Two cases of SCS in patients with cauda equina syndrome after lumbar surgery are presented. They were treated for persistent neuropathic pain but also experienced improvement in their motor and urinary symptoms after this treatment. Although the primary indication for SCS is neuropathic pain control, its application can also lead to improvement of motor deficits, sensory disorders, and urinary incontinence, as shown in these two cases. SCS will likely play a fundamental role in rehabilitative therapies in different neurological diseases. Further investigation in the field is needed.
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21
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Aoki S, Nagashima K, Shibata M, Kasahara H, Fujita Y, Hashiguchi A, Takashima H, Ikeda Y. Sibling Cases of Charcot-Marie-Tooth Disease Type 4H with a Homozygous FGD4 Mutation and Cauda Equina Thickening. Intern Med 2021; 60:3975-3981. [PMID: 34148957 PMCID: PMC8758460 DOI: 10.2169/internalmedicine.7247-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Charcot-Marie-Tooth disease type 4H (CMT4H) is an autosomal recessive inherited demyelinating neuropathy caused by an FYVE, RhoGEF, and a PH domain-containing protein 4 (FGD4) gene mutation. CMT4H is characterized by an early onset, slow progression, scoliosis, distal muscle atrophy, and foot deformities. We herein present sibling cases of CMT4H with a homozygous mutation in the FGD4 gene. Both patients exhibited cauda equina thickening on magnetic resonance imaging, which had not been reported among the previous CMT4H cases. This is the first report of CMT4H with a homozygous FGD4 c.1730G>A (p.Arg577Gln) mutation showing mild progression and cauda equina thickening.
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Affiliation(s)
- Sho Aoki
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Kazuaki Nagashima
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Makoto Shibata
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Hiroo Kasahara
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Yukio Fujita
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
| | - Akihiro Hashiguchi
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Japan
| | - Yoshio Ikeda
- Department of Neurology, Gunma University Graduate School of Medicine, Japan
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22
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Alsaeed M, Lim CAR, Plecash A, Chen T. Paraneoplastic sensorimotor neuropathy and ventral cauda equina nerve root enhancement as initial presentation of small cell lung carcinoma: a case study. BMC Neurol 2021; 21:374. [PMID: 34579672 PMCID: PMC8474708 DOI: 10.1186/s12883-021-02404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Paraneoplastic neurologic syndromes (PNS) are rare, however, are important to recognize as oftentimes they precede the detection of an occult malignancy. Our case highlights a rare circumstance of paraneoplastic radiculoneuropathy and the importance of recognizing PNS in antibody negative disease, as is the case in up to 16% of sensory neuronopathies, and the process of excluding other etiologies. CASE PRESENTATION We discuss a 51-year-old man who presented with asymmetric subacute sensorimotor deficits in the lower limbs. Initial clinical examination showed weakness throughout the right lower limb and normal strength on the left with objective numbness in a mixed dermatomal and stocking-glove distribution. Electrophysiology was consistent with axonal sensorimotor neuropathy. Cerebrospinal fluid showed pleocytosis and elevated protein. Intravenous immunoglobulin treatment was given with some improvement in pain symptoms but no measurable motor improvement. Following clinical and electrophysiologic deterioration the patient was transferred to a tertiary centre. Magnetic resonance imaging of the spine showed smooth enhancement of the ventral caudal nerve roots. Chest computed tomography revealed left lower vascular scarring. Further positron emission tomography scan imaging identified fluorodeoxyglucose avid right lung lymphadenopathy. Bronchoscopy-guided biopsy revealed small cell lung carcinoma. Onconeural and antiganglioside antibodies were negative. The patient was then transferred to a medical oncology ward where he underwent chemoradiotherapy and subsequently experienced improvement in his motor function, supporting that his neurological condition was indeed secondary to a paraneoplastic process. CONCLUSIONS Onconeural negative paraneoplastic radiculoneuropathy can precede diagnosis of small cell lung carcinoma. If considered early and adequately investigated, it can allow earlier diagnosis and treatment of underlying malignancy, improving overall and neurological prognosis.
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Affiliation(s)
- Meshari Alsaeed
- Division of Neurology, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Chloe A R Lim
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alyson Plecash
- Division of Neurology, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Tychicus Chen
- Division of Neurology, Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Hoeritzauer I, Stanton B, Carson A, Stone J. 'Scan-negative' cauda equina syndrome: what to do when there is no neurosurgical cause. Pract Neurol 2021; 22:6-13. [PMID: 34389643 DOI: 10.1136/practneurol-2020-002830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/03/2022]
Abstract
Suspected cauda equina syndrome is a common presentation in emergency departments, but most patients (≥70%) have no cauda equina compression on imaging. As neurologists become more involved with 'front door' neurology, referral rates of patients with these symptoms are increasing. A small proportion of patients without structural pathology have other neurological causes: we discuss the differential diagnosis and how to recognise these. New data on the clinical features of patients with 'scan-negative' cauda equina syndrome suggest that the symptoms are usually triggered by acute pain (with or without root impingement) causing changes in brain-bladder feedback in vulnerable individuals, exacerbated by medication and anxiety, and commonly presenting with features of functional neurological disorder.
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Affiliation(s)
- Ingrid Hoeritzauer
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital, Neuropsychiatry Service, South London & Maudsley NHS Trust, London, UK
| | - Alan Carson
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Jon Stone
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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24
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林 国, 王 振, 谢 京, 刘 彬, 马 长, 陈 晓. [Clinical study of 21 cases of sacral cysts containing fila terminale]. Beijing Da Xue Xue Bao Yi Xue Ban 2020; 52:582-585. [PMID: 32541996 PMCID: PMC7433408 DOI: 10.19723/j.issn.1671-167x.2020.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To summarize the characteristics of sacral cysts containing fila terminale and to explore the surgical treatment methods. METHODS The clinical features, imaging characteristics and surgical methods of 21 cases of sacral cysts containing fila terminale from July 2010 to March 2017 were reviewed and analyzed. Lumbosacral and perineal pain, weakness of the lower limbs and bladder and bowel dysfunction were the common clinical symptoms. MRI showed that the cysts located in the sacral canal. The lower T1 and higher T2 signals were found on MRI. There were fila terminale within the cysts which tethered the spinal cord. No enhancement was visible within the lesion. The key steps of operation included the resection of the cyst wall, the cutting off of the fila terminale, the release of the tethered cord and the reconstruction of the cisterna terminalis. RESULTS The total and subtotal resections of cyst walls were achieved in 14 and 7 cases, respectively. The fila terminales were separated and cut off in all the cases, and the tethered cords were released completely. The reconstructions of the cisterna terminalis were accomplished in all the cases. There was no new-onset dysfunction except for 7 cases of mild numbness around anus postoperatively. Pathological examinations confirmed that the cyst wall was fibrous connective tissue, and hyperplasia of fibrous tissue and/or adipose tissue was found within the thickened fila terminale. The lumbosacral and perineal pain disappeared. The weakness of the lower extremities and the bladder and bowel dysfunction gradually improved. The period of follow-up ranged from 3 months to 7 years (average: 2.25 years). The spinal function of all the patients restored to McCormick grade Ⅰ. Only 1 case encountered recurrence of cyst. CONCLUSION The sacral cysts containing fila terminale are rare. The common symptoms include lumbosacral and perineal pain and symptoms of tethered cord. MRI is helpful to the diagnosis, which shows the signal of cerebrospinal fluid and the fila terminale in the cyst as well as tlow-placed conus medullaris. Microsurgery should remove the cyst wall, cut off the fila terminale, release the tethered cord and reconstruct the cisterna terminalis.
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Affiliation(s)
- 国中 林
- />北京大学第三医院神经外科,北京 100191Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
| | - 振宇 王
- />北京大学第三医院神经外科,北京 100191Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
| | - 京城 谢
- />北京大学第三医院神经外科,北京 100191Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
| | - 彬 刘
- />北京大学第三医院神经外科,北京 100191Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
| | - 长城 马
- />北京大学第三医院神经外科,北京 100191Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
| | - 晓东 陈
- />北京大学第三医院神经外科,北京 100191Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China
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Ting SL, Jobli AT, Sim SK, Norlida Awang Ojep DK. Myxopapillary ependymoma of cauda equina presented with communicating hydrocephalus and papilloedema: A case report. Med J Malaysia 2019; 74:338-340. [PMID: 31424046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We reported a case of cauda equina myxopapillary ependymoma in a patient who presented with atypical history of progressive blurring of vision. Ophthalmology examination revealed relative afferent pupillary defect, binasal hemianopia and papilloedema. This case report serves as a reminder that the intraspinal tumour could be a cause of papilloedema, despite rare, should be considered in a hydrocephalus patient who presented with no intracranial pathology and minimal spinal symptoms.
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Affiliation(s)
- S L Ting
- Universiti Malaysia Sarawak (UNIMAS), Faculty of Medicine and Health Sciences, Department of Ophthalmology, Sarawak, Malaysia.
| | - A T Jobli
- Universiti Malaysia Sarawak (UNIMAS), Faculty of Medicine and Health Sciences, Department of Radiology, Sarawak, Malaysia
| | - S K Sim
- Universiti Malaysia Sarawak (UNIMAS), Faculty of Medicine and Health Sciences, Department of Surgery, Sarawak, Malaysia
| | - D K Norlida Awang Ojep
- Universiti Malaysia Sarawak (UNIMAS), Faculty of Medicine and Health Sciences, Department of Pathology, Sarawak, Malaysia
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Jiménez-Ávila JM, Castañeda-Huerta JE, González-Cisneros AC. [Bruns Garland syndrome. Report of a case and differential diagnosis with cauda equina syndrome]. Acta Ortop Mex 2019; 33:42-45. [PMID: 31480126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The Bruns Garland syndrome (diabetic amyotrophy) it is a very rare condition, with few cases reported in the literature. Clinical differentiation of diabetic amyotrophy or cauda equine syndrome may be difficult. The issue of misdiagnosis has been discussed as a reason for poor outcome after lumbar spine surgery. We report a case of diabetic amyotrophy that mimics a cauda equina syndrome. CASE DESCRIPTION A 59 years old man diabetic patient that suddenly begins with weakness of lower extremities and loss of sphincters control. The patient was seen in the emergency room, the anteroposterior and lateral radiographs of the lumbosacral spine evidenced spondylolisthesis L5-S1 level II of Meyerding. However, the MRI show no vertebral canal compression, nerve root compression or disc extrusion. Electrodiagnostic study revealed diabetic amyotrophy (Bruns Garland syndrome). The patient rapidly improves with treatment based in antineuritics, diabetes control, physical therapy and rehabilitation. Four months after the diagnosis he recover his muscle strength, has no alterations in the march, no loss of balance, his sensitive is preserved and has no pain. CONCLUSION Electrodiagnostic and radiologic studies should be used in every diabetic patient presenting with leg pain and/or weakness to differentiate diabetic neuropathy from cauda equina syndrome. Treatment of both diseases may be needed for relief of the patients pain.
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Affiliation(s)
- J M Jiménez-Ávila
- Hospital del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS). Guadalajara, México
- Escuela de Medicina del Instituto Tecnológico de Monterrey. Guadalajara, Jalisco, México
| | - J E Castañeda-Huerta
- Hospital del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social (IMSS). Guadalajara, México
| | - A C González-Cisneros
- Escuela de Medicina del Instituto Tecnológico de Monterrey. Guadalajara, Jalisco, México
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Evzikov GY, Konovalov NA, Bashlachev MG, Asyutin DS, Onoprienko RA, Korolishin VA, Timonin SY, Panina TN, Belozerskikh KA. [Surgical treatment of intramedullary-extramedullary ependymomas. Two clinical cases and a literature review]. Zh Vopr Neirokhir Im N N Burdenko 2018; 82:48-55. [PMID: 29927425 DOI: 10.17116/neiro201882348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED Ependymoma is a central nervous system tumor that grows from ependymal cells lining the cerebral ventricles, central canal of the spinal cord, and filum terminale. Regardless of the histological type of ependymomas, they rarely have exophytic growth. Because of an extremely low occurrence rate of this phenomenon, we present two clinical cases of patients with classical intramedullary ependymomas (Grade II) having an extramedullary component. MATERIAL AND METHODS The paper presents two clinical cases of patients with intramedullary-extramedullary ependymomas of the spinal cord. The surgical technique is described. After surgical treatment, the performance status of patients remained unchanged. CONCLUSION Radical removal of complex ependymomas provides conditions for long-term disease-free survival and further neurological recovery.
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Affiliation(s)
- G Yu Evzikov
- Sechenov First Moscow State Medical University, Clinic of Nervous Diseases, Rossolimo Str., 11, Moscow, Russia, 119021
| | - N A Konovalov
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - M G Bashlachev
- Sechenov First Moscow State Medical University, Clinic of Nervous Diseases, Rossolimo Str., 11, Moscow, Russia, 119021
| | - D S Asyutin
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - R A Onoprienko
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - V A Korolishin
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - S Yu Timonin
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - T N Panina
- Burdenko Neurosurgical Institute, 4-ya Tverskaya-Yamskaya Str., 16, Moscow, Russia, 125047
| | - K A Belozerskikh
- Sechenov First Moscow State Medical University, Clinic of Nervous Diseases, Rossolimo Str., 11, Moscow, Russia, 119021
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Sharr MM. Diagnosis of spinal cord and cauda equina metastases. Prog Exp Tumor Res 2015; 29:93-104. [PMID: 4070640 DOI: 10.1159/000411629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Matsuda N, Kobayashi S, Matsumoto H, Machii M, Soeda T, Ugawa Y. Cauda equina involvement in post-radiation lower motor neuron syndrome. Intern Med 2015; 54:1415-9. [PMID: 26027999 DOI: 10.2169/internalmedicine.54.4182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Post-radiation lower motor neuron syndrome (PRLMNS) is a rare neurological complication of radiation therapy and its pathogenesis is unclear. We herein report a patient with PRLMNS who developed leg weakness 17 years after craniospinal radiation as a treatment for suprasellar germinoma. The electrophysiological evaluation, via a novel magnetic stimulation method, indicated a prolonged cauda equina conduction time, suggesting focal demyelination of the nerve roots in the cauda equina. The distribution of the denervated muscles detected by magnetic resonance imaging was consistent with patchy motor nerve root lesions. These results support the hypothesis that PRLMNS originates from ischemic radiculopathy in the cauda equina.
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Affiliation(s)
- Nozomu Matsuda
- Department of Neurology, Fukushima Medical University, Japan
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Allorent J, Cozic C, Guimard T, Tanguy G, Cormier G. Sciatica with motor loss and hemi- cauda equina syndrome due to varicella-zoster virus meningoradiculitis. Joint Bone Spine 2013; 80:436-7. [PMID: 23453474 DOI: 10.1016/j.jbspin.2012.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2012] [Indexed: 11/28/2022]
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Hong JY, Hur CY, Modi HN, Suh SW, Chang HY. Paraganglioma in the cauda equina. A case report. Acta Orthop Belg 2012; 78:418-423. [PMID: 22822588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Paraganglioma of the cauda equina is rare, and diagnosis is difficult. A 47-year-old woman presented with backache, with a 2-year history of pain radiating in her right lower extremity. Initial neurologic examination revealed mild hypaesthesia in the L4 dermatome on both sides. Spine MRI showed a well-delinated intradural extramedullary mass compressing the spinal cord. It extended from L2 to L4, with anterior compression of the spinal cord which was displaced posteriorly. Clinical and radiological findings suggested an ependymoma. Surgical decompression was performed from L2 to L4 through lumbar laminectomy under microscope. Intraoperatively, the patient experienced unexplained paroxysmal hypertension while manipulating the tumour, which was not relieved by hypotensive medication but resolved immediately after resection of the mass. Postoperatively, the neurologic status improved and the radiating pain was relieved. Histopathologic examination showed cellular perivascular arrangement which looked like 'pseudorosettes'. Taken together, these histologic and radiologic findings suggested a benign myxopapillary ependymoma. However, immunohistochemical examination showed reactivity with synaptophysin and chromogranin. Finally, histological examination of the specimen revealed a 'Zellballen' pattern of paraganglioma, and the final diagnosis of paraganglioma with secreting function was confirmed. Paraganglioma is a rare tumour that can exhibit a secreting function causing paroxysmal hypertension which may be life threatening. Therefore, the differential diagnosis is important. The diagnosis is based on close examination of the clinical, radiologic and pathologic findings.
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Affiliation(s)
- Jae-Young Hong
- Department of Orthopedics, Korea University Guro Hospital, Seoul, South Korea
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Wostrack M, Pape H, Kreutzer J, Ringel F, Meyer B, Stoffel M. Surgical treatment of spinal intradural carcinoma metastases. Acta Neurochir (Wien) 2012; 154:349-57. [PMID: 22009015 DOI: 10.1007/s00701-011-1204-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 10/04/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intradural metastases of nonneurogenic origin represent an extremely rare manifestation of systemic cancer. The respective literature is very scarce. METHODS We retrospectively evaluated nine patients with intradural metastases treated surgically from March 2006 until today at our department. RESULTS Four metastases were intramedullary and five intradural extramedullary. Localisation along the spine involved: cervical n = 3, thoracic n = 3, and conus/cauda n = 3. Five patients were female and four male, with a median age of 71 years. Histology showed: breast cancer n = 2, NSCLC (non-small cell lung cancer) n = 2, SCLC (small cell lung cancer) n = 1, colon carcinoma n = 1, malignant skin melanoma n = 1, squamous cell carcinoma of the skin n = 1, and ovarian carcinoma n = 1. Holospinal dissemination in terms of leptomeningeal carcinomatosis according to MRI or positive CSF (cerebrospinal fluid) cytology, respectively, was found in four patients. Gross total resection was achieved in four patients and debulking in five. Results of surgical decompression were: six patients (67%) exhibited immediate improvement of neurological symptoms and/or pain; four of them even improved according to the McCormick Scale score (44%); two patients (22%) were unchanged, and one (11%) exhibited worsening of neurological symptoms after surgery. Median survival time after surgery was 7.3 months. CONCLUSIONS Intradural metastases are associated with limited survival time. Accordingly, the aim of surgery is strictly palliative. The majority of patients benefit with respect to neurological deficit/pain (67%) independent of the extent of resection. Thus, decompressive surgery is recommended to increase the quality of life.
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Affiliation(s)
- Maria Wostrack
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 18675 Munich, Germany.
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Abstract
OBJECTIVES The objectives were to evaluate the presenting signs and symptoms of spinal cord and cauda equina compression (SCC) and to determine the incidence of emergency department (ED) misdiagnosis. METHODS This was a retrospective chart review at an urban, tertiary care hospital of patients discharged from an inpatient stay (April 2008 through July 2009) with an International Classification of Diseases, Ninth Revision (ICD-9) code indicating spinal disease, who had visited the ED for a related complaint within the previous 30 days, and who had a final diagnosis of new SCC. Trauma and transferred patients were excluded. The authors defined a misdiagnosis as no ED-documented diagnosis of SCC and failure to perform an appropriate diagnostic study either prior to arrival, in the ED, or immediately upon admission. RESULTS Of 1,231 charts reviewed, 63 met inclusion criteria. The most common presenting symptoms in patients with SCC were pain (44, 70%), difficulty ambulating (38, 60%), and weakness (35, 56%). On physical examination, motor deficits (45, 71%) were more common than sensory deficits (27, 43%); however, 15 (24%) patients had no motor or sensory deficit, and 13 (23%) patients only had unilateral findings. Impaired gait was present in 14 patients of only 20 tested, three of whom had no associated motor or sensory deficit. SCC was misdiagnosed in 18 (29%, 95% confidence interval [CI] = 19% to 41%) cases, which resulted in a significant delay to diagnosis (median = 54 hours, interquartile range [IQR] = 38 to 77 vs. 5.3 hours, IQR = 3.0 to 15) in these patients. CONCLUSIONS SCC can have a subtle presentation with absent or unilateral motor and sensory deficits, but gait ataxia may be an additional finding. ED misdiagnosis of SCC in nontrauma patients is common.
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Affiliation(s)
- Andrea F Dugas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Li HP, Liu Y, He XJ, Xe SY, Chen J, Feng DX. [P75 neurotrophin receptor mRNA sequential expression and significance after Cauda equina compression in rats]. Zhongguo Gu Shang 2011; 24:509-513. [PMID: 21786560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To observe the mRNA expression of p75NTR (p75 neurotrophin receptor) and the amount of neuronal cells apoptosis in lumbar-sacral spinal cord at different time points after the acute cauda equina compression in rats and to explore their correlation. METHODS Sixty adult female Sprague Dawley(SD) rats were randomly divided into the normal control group and the compression groups. The acute cauda equine compression model was established as placing a silicon gel rubber at L(3,4) level of the vertebral canal which represented about 70% to 80% compression to the cross section. The whole L(1,2) level of spinal cords were harvested at 1, 3, 5, 7, 14, 28 d after operation in compression group. Tunel method was applied to observe cell apoptosis and RT-PCR was used to detect the p75NTR mRNA expression. SPSS 13.0 statistical software was adopted to help analysis. RESULTS In the compression group, both the nerve cells apoptosis and the p75 mRNA expression existed the trend of low-high-low synchronally compared with the control group, there was a significant difference (P < 0.05) among comprssion groups at different time points,there was a significant difference in changes (P < 0.05). p75NTR of mRNA expression and lumbosacral nerve cells apoptosis was in a positive correlation. CONCLUSION After acute cauda equina compression, p75NTR mRNA expression is closely related to the neuronal apoptosis, which plays an important role in the molecular mechanism of the CES.
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Affiliation(s)
- Hao-peng Li
- The Second Department of Orthopaedics, the Second Hospital Affiliated to Medical College of Jiaotong University of Xi 'an, Xi'an 710004, Shaanxi, China.
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Gheith O, Ammar H, Akl A, Hamdy A, El-Saeed M, El-Salamouny T, Bakr MA, Ghoneim M. Spinal compression by brown tumor in two patients with chronic kidney allograft failure on maintenance hemodialysis. Iran J Kidney Dis 2010; 4:256-259. [PMID: 20622318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Brown tumors with non-neoplastic process are noticed in patients with end-stage renal disease suffering from a severe form of secondary hyperparathyroidism. Herein, we report a patient with chronic kidney allograft failure returned back to hemodialysis who experienced manifestations of cauda equina compression secondary to a lumbar brown tumor. Also, we had another patient on hemodialysis with a demineralized lesion affecting the cervical vertebrae. Although brown tumor is a rare complication, these two cases highlighted the importance of neurological symptoms in uremic patients. Spinal decompression surgery, in order to alleviate pressure on neurological structures, together with subtotal parathyroidectomy, were highly indicated.
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Affiliation(s)
- Osama Gheith
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.
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Bekkali NLH, Hagebeuk EEO, Bongers MEJ, van Rijn RR, Van Wijk MP, Liem O, Benninga MA. Magnetic resonance imaging of the lumbosacral spine in children with chronic constipation or non-retentive fecal incontinence: a prospective study. J Pediatr 2010; 156:461-5. [PMID: 19892365 DOI: 10.1016/j.jpeds.2009.09.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2009] [Revised: 07/16/2009] [Accepted: 09/17/2009] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the prevalence of lumbosacral spine (LSS) abnormalities in children with defecation disorders, intractable constipation, or non-retentive fecal incontinence (NRFI) and evaluate whether LSS abnormalities on magnetic resonance imaging (MRI) are clinically detected by neurologic examination. STUDY DESIGN MRI of the LSS and complete neurologic examination by a pediatric neurologist blinded to the MRI results were performed in patients with intractable defecation disorders. RESULTS Patients with intractable constipation (n = 130; 76 males; median age, 11 years; range, 6-18 years), and patients with NRFI (n = 28; 18 males; median age, 10 years; range, 7-15 years) participated. One occult spina bifida (OSB) and 3 terminal filum lipomas were found in patients with a normal neurologic examination. One patient had a terminal filum lipoma and neurologic complaints. Gluteal cleft deviation was found in 3 of 4 patients with LSS abnormalities. Neurosurgical treatment was not required in any patient during the 12-week follow-up. CONCLUSIONS MRI showed LSS abnormalities in 3% of patients with defecation disorders and normal neurologic examination, all of whom reported symptom relief at the 12-week follow-up without neurosurgical intervention. Thus, whether or not LSS abnormalities play a role in defecation disorders remains unclear.
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Affiliation(s)
- Noor-L-Houda Bekkali
- Department of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital, Academic Medical Centre, Amsterdam, The Netherlands.
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Ronen J, Goldin D, Itzkovich M, Bluvshtein V, Gelernter I, Livshitz A, Folman Y, Catz A. Outcomes in patients admitted for rehabilitation with spinal cord or cauda equina lesions following degenerative spinal stenosis. Disabil Rehabil 2009; 27:884-9. [PMID: 16096240 DOI: 10.1080/09638280500030886] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate outcome measures and the factors affecting them in patients treated between 1962 and 2000 at Loewenstein Rehabilitation Hospital, Israel. METHOD This retrospective cohort study included 262 patients with spinal neurological lesions (spinal cord or cauda equina lesions) following degenerative spinal stenosis. Data were collected retrospectively. Survival was assessed using the Kaplan-Meier method and the relative mortality risk by the Cox model. Neurological recovery was evaluated by the change in Frankel grades, and factors that affect it were assessed by logistic regression. Associations of length of stay in rehabilitation were analyzed with ANOVA. RESULTS Median age at lesion onset was 61 years and median survival 17.6 years. Age at spinal neurological lesion onset was found to be the only factor with a significant effect on survival. Of the 148 patients who had Frankel grades A, B, or C on admission, 58% achieved recovery to grades D and E. Frankel grade at admission, age, and spinal neurological level had a significant effect on recovery. The mean length of stay was 99.7 days, and only Frankel grade had a significant effect on length of stay. CONCLUSIONS Patients with spinal stenosis and disabling spinal neurological lesions can achieve significant neurological recovery and survive for many years. They require adequate care in a specialist rehabilitation system.
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Affiliation(s)
- Jacob Ronen
- Department IV, Spinal Rehabilitation, Loewenstein Rehabilitation Hospital, Raanana, Israel
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Marcol W, Kiwic G, Malinowska-Kolodziej I, Kotulska K, Kotas A, Adamek D, Wysokinski T. Paraganglioma of the cauda equina presenting with erectile and sphincter dysfunction. J Chin Med Assoc 2009; 72:328-31. [PMID: 19541569 DOI: 10.1016/s1726-4901(09)70380-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Paragangliomas of the cauda equina are rare neuroepithelial tumors, usually manifesting clinically as sciatica. Here, we report a case of cauda equina paraganglioma with an unusual course in a 43-year-old man. His main complaints were erectile and sphincter dysfunction. The low back pain was initially ascribed to accidental injury. Magnetic resonance imaging revealed intradural tumor at the L2/L3 level. The patient underwent gross tumor resection, and the diagnosis of paraganglioma was based on neuropathologic examination. The symptoms completely resolved after tumor resection.
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Affiliation(s)
- Wieslaw Marcol
- Department of Neurosurgery, Wojewodzki Szpital Specjalistyczny Nr. 2, Jastrzebie-Zdroj, Poland.
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Grynderup V. Cauda equina lesion from lumbar disc prolapse. Acta Neurol Scand 2009; 46:267-8. [PMID: 5457848 DOI: 10.1111/j.1600-0404.1970.tb02222.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Konishi S, Nakamura H, Kato M, Toyoda H, Dozono M. Cauda equina tumor mimicking an intradural disc herniation, with emphasis on differential diagnosis--a case report. Acta Neurol Belg 2008; 108:167-169. [PMID: 19239048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report a rare case of lumbar disc prolapse with intradural schwannoma at the same level. A 33-year-old man had had moderate right leg pain for about four years, which had worsened suddenly when he lifted heavy baggage. MR imaging revealed lumbar disc prolapse at L4/5. An intradural tumor that was iso-intense on T1-weighted and slightly hyperintense on T2-weighted images was also recognized at the same level. The tumor was homogeneously enhanced on Gadolinium-MRI (Gd-MRI). Intractable back and leg pain necessitated surgical treatment, which yielded a definitive diagnosis of the intradural tumor as schwannoma on histological examination. The intractable pain disappeared immediately after surgery. The patient's intractable and prolonged pain appeared to be due to combined compression by the intradural tumor and disc prolapse. The findings of Gadolinium-MRI were helpful in making the diagnosis.
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Affiliation(s)
- S Konishi
- Department of Orthopaedic Surgery, Osaka City General Hospital, 2-13-11 Miyakojimahondori Miyakojima-ku Osaka 534-0021, Japan
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Liu N, He F, Wang H, Huang GL, Man LB, Liao LM. [Urodynamic analysis of the chronic impairment of cauda equina caused by lumbar disk herniation]. Zhonghua Wai Ke Za Zhi 2008; 46:1494-1496. [PMID: 19094630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the urodynamic characteristics of the chronic impairment of cauda equina caused by lumbar disk herniation. METHODS Clinical data and urodynamic parameters of 67 male patients with lumbar disk herniation were retrospectively analyzed. Lower urinary obstruction was excluded from the cohort using the Lin-PURR analysis. Patients were divided into group A (normal detrusor function), group B (detrusor underactivity) and group C (detrusor areflexia) according to the detrusor contraction function analyzed in Lin-PURR. Clinical data and urodynamic parameters were analyzed statistically between these groups. RESULTS The category of the detrusor contraction function had a significant effect on the urodynamic parameters. There were significant differences in the maximum flow rate (Q(max)), maximum pressure (P(max)), pressure at the maximum flow (P(det Qmax)) and post-voiding residual urine (PVR) among group A, B and C. There were significant differences in the first sensation volume of the bladder and the maximum cystometric capacity between group A and C, B and C, but no significance was found between group A and B. There was no significant difference in age, disease duration, and compliance of the bladder among 3 groups. CONCLUSIONS Urodynamic study is important in exploring the severity of the chronic impairment of cauda equina caused by lumbar disk herniation. Detrusor areflexia and loss of bladder sensory indicate more severe degree of impairment of the cauda equine. Q(max) and PVR are helpful in early diagnosis of the chronic impairment of cauda equina.
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Affiliation(s)
- Ning Liu
- Department of Urology, Beijing Jishuitan Hospital, Beijing 100035, China
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Iliadis C, Kirgiannis K, Wozniak G, Vlychou M, Santarius T, Kirollos RW. Paraganglioma of cauda equina. Neurol Neurochir Pol 2008; 42:463-466. [PMID: 19105116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The clinical, radiological and pathological features of a paraganglioma resulting in cauda equina syndrome are described, including magnetic resonance imaging features. The literature is reviewed and discussed.
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Affiliation(s)
- Charalambos Iliadis
- Department of Radiology, University Hospital of Larissa, Mezourlo 41110, Larissa, Greece
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Sonia Z, Mounir T, Sarra M, Inès K, Badreddine S, Moncef M, Sadok K. [Paraganglioma in a particular location]. Tunis Med 2008; 86:767. [PMID: 19472768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Caruso R, Marrocco L, Wierzbiki V. Papilledema and tumours of the cauda equina: a case report. Clin Ter 2008; 159:83-85. [PMID: 18463772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Bilateral papilledema is a rare symptom of cauda equina tumours. The authors report a case of neurinoma of cauda equina, which had a bilateral papilledema among its initial symptoms. CASE REPORT A 28 years old man showed the presence of a bilateral papilledema; a cerebral MRI did not show any endocranial pathology. After three months the patient started suffering, especially at night, of right-leg-sciatica. A lumbar MRI showed a neurinoma of the cauda equina. The patient was operated and after surgery the papilledema slowly shrank. CONCLUSIONS The tumours of cauda equina could cause endocranial hypertension and consequently a papilledema because of hyperproteinorachia. If there is a bilateral papilledema and the cerebral MRI does not show any endocranial pathology, there is the need for the examination of any spinal disorders.
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Affiliation(s)
- R Caruso
- Rome Army Medical Center and Department of Neurological Sciences, Rome University Sapienza, Rome, Italy.
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Kayaoglu CR, Sengul G, Aydin IH. Multiple schwannomas of cauda equina in the absence of von Recklinghausen's disease. Saudi Med J 2007; 28:1907-1909. [PMID: 18060228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Multiple schwannomas in the absence of neurofibromatosis is rarely reported in the literature. We present a 56-year-old female with a history of severe leg and back pain on the left side for one year. Magnetic resonance imaging revealed 4 schwannomas located in the cauda equina in the absence of von Recklinghausen's disease.
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Affiliation(s)
- Cetin R Kayaoglu
- Department of Neurosurgery, Medical School, Ataturk University, Erzurum, Turkey
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Abstract
Extramedullary hematopoiesis (EMH) is occasionally reported in idiopathic myelofibrosis and is generally found in the liver, spleen, and lymph nodes several years after diagnosis. Myelofibrosis presenting as spinal cord compression, resulting from EMH tissue is very rare. A 39-yr-old man presented with back pain, subjective weakness and numbness in both legs. Sagittal magnetic resonance imaging showed multiple anterior epidural mass extending from L4 to S1 with compression of cauda equina and nerve root. The patient underwent gross total removal of the mass via L4, 5, and S1 laminectomy. Histological analysis showed islands of myelopoietic cells surrounded by fatty tissue, consistent with EMH, and bone marrow biopsy performed after surgery revealed hypercellular marrow and megakaryocytic hyperplasia and focal fibrosis. The final diagnosis was chronic idiopathic myelofibrosis leading to EMH in the lumbar spinal canal. Since there were no abnormal hematological findings except mild myelofibrosis, additional treatment such as radiothepary was not administered postoperatively for fear of radiotoxicity. On 6 month follow- up examination, the patient remained clinically stable without recurrence. This is the first case of chronic idiopathic myelofibrosis due to EMH tissue in the lumbar spinal canal in Korea.
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Affiliation(s)
- Duck-Ho Goh
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dae-Chul Cho
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Seong-Hyun Park
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jeong-Hyun Hwang
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Joo-Kyung Sung
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea
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