Cauda Equina Syndrome

2000 ◽  
Vol 5 (1) ◽  
pp. 1-2
Author(s):  
Leon H. Ensalada
Keyword(s):  
Lower Extremity ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Leg Pain ◽  
Lower Extremity Function ◽  
Lower Extremity Weakness ◽  
Injury Model ◽  
History Of ◽  
Radicular Syndrome ◽  
Lumbar Spinal

Abstract The cauda equina is a collection of peripheral nerves in the common dural sheath within the lumbar spinal canal. Cauda equina syndrome, also known as bilateral acute radicular syndrome, usually is caused by a large, sequestered acute disc rupture at L3-4, L4-5, or L5-S1 that produces partial or complete lesions of the cauda equina–lower motor neuron lesions associated with flaccid paralysis, atrophy, and other conditions. Patients usually present with a history of back symptoms that have worsened precipitously. The syndrome includes back pain, bilateral leg pain, saddle anesthesia, bilateral lower extremity weakness, urinary bladder retention, and lax rectal tone. Cauda equina syndrome is rated using Diagnosis-related estimates (DRE) lumbosacral categories VI or VII. Category VI, Cauda Equina–like Syndrome Without Bowel or Bladder Signs, is used when there is permanent bilateral partial loss of lower extremity function but no bowel or bladder impairment. Category VII, Cauda Equina Syndrome with Bowel or Bladder Impairment, is similar to Category VI but also includes bowel or bladder impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) uses the term cauda equina syndrome with reference to both the thoracolumbar and cervicothoracic spine regions; this usage is unique to the AMA Guides but maintains the internal consistency of the Injury Model, which is the best approach to date for assessing spine impairment.

scholarly journals Examination Findings and Self-Reported Walking Capacity in Patients With Lumbar Spinal Stenosis

2001 ◽  
Vol 81 (7) ◽  
pp. 1296-1306 ◽  
Author(s):  
Maura D Iversen ◽  
Jeffrey N Katz
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lower Extremity ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Cauda Equina ◽  
Low Back ◽  
Lower Extremity Weakness ◽  
Walking Capacity ◽  
Lumbar Spinal

AbstractBackground and Purpose. Spinal stenosis is a common, often disabling, condition resulting from compression of the cauda equina and nerve roots. This study was designed to: (1) characterize the impairments of patients with lumbar spinal stenosis (LSS) and (2) to identify predictors of self-reported walking capacity. Subjects. Forty-three patients with symptomatic LSS, from 3 specialty clinics, were evaluated. Twenty-eight subjects (65%) were female. The subjects' median age was 73.6 years (X̄=72.4, SD=10.3, range=45.–90.7), and the median duration of low back pain was 24 months (X̄=36.6, SD=41.6, range=0–216). Methods. Demographic data, medical history, and information about low back pain and symptoms (eg, numbness, tingling, and lower-extremity weakness) were collected using a standardized questionnaire and physical examination. Results. Twenty-two subjects (51%) had lower-extremity weakness, primarily of the extensor hallucis longus muscle. Thirty-five subjects (81%) had absent or decreased neurosensory responses (eg, pinprick, vibration, reflexes), and 28 subjects (66%) reported that they were unable to walk farther than 2 blocks. Women were more likely than men to report difficulties walking, as were subjects with abnormal Romberg test scores and those with greater pain during walking. Discussion and Conclusion. Pain and balance problems appeared to be the primary factors limiting ambulation in our subjects with LSS.

Cystic Dilation of the Conus Ventriculus Terminalis Presenting as an Acute Cauda Equina Syndrome Relieved by Decompression and Cyst Drainage: Case Report

Neurosurgery ◽  
2006 ◽  
Vol 58 (3) ◽  
pp. E585-E585 ◽  
Author(s):  
Jonathan L. Brisman ◽  
Maria Li ◽  
Dean Hamilton ◽  
Marc R. Mayberg ◽  
David W. Newell
Keyword(s):  
Lower Extremity ◽  
Cauda Equina Syndrome ◽  
Clinical Presentation ◽  
Cauda Equina ◽  
Clinical Results ◽  
Surgical Decompression ◽  
Cystic Dilatation ◽  
Simple Cyst ◽  
Lower Extremity Weakness ◽  
Lower Extremity Strength

Abstract OBJECTIVE AND IMPORTANCE: The ventriculus terminalis of the conus, or "fifth ventricle" refers to the ependymal-lined space in the middle of the conus that is present in childhood and whose persistence into adulthood is rare. A number of cases of cystic dilatation of the ventriculus terminalis have been described in adulthood. Patients tend to present with either pain alone or gradually progressive conus or cauda equina syndromes with varying degrees of recovery after cyst drainage. Presentation with an acute cauda equina syndrome and its successful surgical management has not been previously reported. CLINICAL PRESENTATION: A 57-year-old woman experienced back pain and bilateral sciatica ascribed to diabetic neuropathy for 2 years. Over a 24-hour period she developed bilateral lower extremity weakness, saddle anesthesia, and bowel and bladder incontinence. Lumbosacral magnetic resonance imaging demonstrated a large cystic dilatation of the ventriculus terminalis. INTERVENTION: She was taken for emergency surgical decompression and cyst drainage. Immediately after surgery, she experienced significant increase in lower extremity strength and has since regained continence. CONCLUSION: Cystic dilation of the ventriculus terminalis should be part of the differential diagnosis for a cauda equina syndrome; surgical decompression with simple cyst drainage can result in excellent clinical results.

Just the facts: Risk stratifying nontraumatic back pain for Cauda Equina Syndrome in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 652-654
Author(s):  
Zoe Polsky ◽  
Margriet Greidanus ◽  
Anjali Pandya ◽  
W. Bradley Jacobs
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Bowel Movement ◽  
Chronic Back Pain ◽  
Cauda Equina ◽  
Digital Rectal Examination ◽  
Acute Onset ◽  
Clinical Exam ◽  
History Of

A 43-year-old male, with a history of chronic back pain, presents to the emergency department (ED) with acute onset chronic pain. He states he “tweaked something” and has been debilitated by back pain, radiating down both his legs, for 24 hours. He has not had a bowel movement but denies noticing any “saddle anesthesia.” His clinical exam is limited by pain, and it is difficult to determine if he has objective weakness. His perineal sensation is intact, as is his sensation upon digital rectal examination. The patient has a post-void residual of 250 mL, but you are unsure how to interpret this value. As an emergency physician, when should you suspect, and how should you evaluate cauda equina syndrome?

scholarly journals Cauda Equina Syndrome Secondary to Leptomeningeal Carcinomatosis of Gastroesophageal Junction Cancer

2016 ◽  
Vol 8 (1) ◽  
pp. 87-91 ◽  
Author(s):  
Amal Alkhotani ◽  
Nouf Alrishi ◽  
M. Salem Alhalabi ◽  
Tahira Hamid
Keyword(s):  
Cauda Equina Syndrome ◽  
Gastroesophageal Junction ◽  
Cauda Equina ◽  
Leptomeningeal Carcinomatosis ◽  
Leg Pain ◽  
Urine Retention ◽  
Gastroesophageal Junction Cancer ◽  
First Case ◽  
Facial Diplegia ◽  
Leg Weakness

Leptomeningeal carcinomatosis (LMC) is a diffuse or multifocal malignant infiltration of the pia matter and arachnoid membrane. The most commonly reported cancers associated with LMC are breast, lung, and hematological malignancies. Patients with LMC commonly present with multifocal neurological symptoms. We report a case of LMC secondary to gastroesophageal junction cancer present initially with cauda equina syndrome. A 51-year-old male patient with treated adenocarcinoma of the gastroesophageal junction presented with left leg pain, mild weakness, and saddle area numbness. Initial radiological examinations were unremarkable. Subsequently, he had worsening of his leg weakness, fecal incontinence, and urine retention. Two days later, he developed rapidly progressive cranial neuropathies including facial diplegia, sensorineural hearing loss, dysarthria, and dysphagia. MRI with and without contrast showed diffuse enhancement of leptomeninges surrounding the brain, spinal cord, and cauda equina extending to the nerve roots. Cerebrospinal fluid cytology was positive for malignant cells. The patient died within 10 days from the second presentation. In cancer patients with cauda equina syndrome and absence of structural lesion on imaging, LMC should be considered. To our knowledge, this is the first case of LMC secondary to gastroesophageal cancer presenting with cauda equina syndrome.

scholarly journals Cauda equina syndrome without motor dysfunction following lumbar spinal stenosis surgery

Medicine ◽  
2019 ◽  
Vol 98 (29) ◽  
pp. e16396
Author(s):  
Tianyang Yuan ◽  
Jun Zhang ◽  
Lili Yang ◽  
Jiuping Wu ◽  
Haiqing Tian ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Motor Dysfunction ◽  
Lumbar Spinal

Neurocytoma of the cauda equina

1999 ◽  
Vol 90 (2) ◽  
pp. 247-251 ◽  
Author(s):  
Christina L. Stephan ◽  
John J. Kepes ◽  
Paul Arnold ◽  
K. Douglas Green ◽  
Fran Chamberlin
Keyword(s):  
Magnetic Resonance ◽  
Nerve Root ◽  
Magnetic Resonance Image ◽  
Cauda Equina ◽  
Pertinent Literature ◽  
Lower Extremity Weakness ◽  
Content Type ◽  
Left Lower Extremity ◽  
History Of ◽  
Fine Print

✓ A case of a neurocytoma involving a nerve root of the cauda equina in a 46-year-old woman is reported. The patient presented with a 2-month history of progressive left lower-extremity weakness and pain and decreased ability to walk, as well as complaints of incomplete voiding. A magnetic resonance image revealed a 7-mm oval mass that was located intrathecally and extended from T-12 to L-1 and was adjacent to a nerve root. No lesions were identified at higher vertebral levels. The mass was excised. On histological examination it was found to have classical features of a neurocytoma. To the best of the authors' knowledge, this is the first report of a neurocytoma occurring in that region. A detailed histological description of this case and review of the pertinent literature are provided.

scholarly journals Reduction in leg pain and lower-extremity weakness with Oxiplex/SP Gel for 1 year after laminectomy, laminotomy, and discectomy

2004 ◽  
Vol 17 (1) ◽  
pp. 1-6 ◽  
Author(s):  
Kee D. Kim ◽  
Jeffrey C. Wang ◽  
Daniel P. Robertson ◽  
Darrel S. Brodke ◽  
Mohammed BenDebba ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Radicular Pain ◽  
Leg Pain ◽  
Control Group ◽  
Self Assessment ◽  
Lower Extremity Weakness ◽  
Reduction Of Pain ◽  
Pain Symptoms

Object Although good surgical technique is effective in reducing postoperative epidural fibrosis, compression or tethering of the nerve root may cause recurrent radicular pain and physical impairment. The implantation of a bioresorbable gel on the dura may further decrease the amount of scar formation after surgery and thus improve the patient's ability to perform activities of daily living (ADL). This study is a 12-month evaluation of the safety and effectiveness of Oxiplex/SP Gel (FzioMed, Inc., San Luis Obispo, CA) in the reduction of pain and radiculopathy after lumbar discectomy. Methods A pilot randomized single-blind multicenter clinical trial was conducted to evaluate the performance of Oxiplex/SP Gel in patients who underwent surgery for unilateral herniation of the lumbar disc at L4–5 or L5–S1. Eighteen patients with severe leg pain and lower-extremity weakness (11 women and seven men) were randomly assigned intraoperatively to receive the gel at the conclusion of surgery (treatment group) or to undergo surgery alone (control group). Self-assessment questionnaires (Lumbar Spine Outcomes Questionnaire) to assess pain, symptoms, and ADL were completed preoperatively and at scheduled postoperative intervals (30 days, 90 days, 6 months, and 12 months). The authors examined the spine and lower extremities of patients scheduled for discectomy to assess neurological function and pain. Treated patients received sufficient Oxiplex/SP Gel (1–3 ml) to coat the nerve root and fill the epidural space. Postoperative clinical evaluations were performed at 30 and 90 days. Patients completed the self-assessment questionnaires at baseline and were contacted by telephone or mail for the completion of the postoperative self-assessment questionnaires. Surgical procedures were well tolerated; no device-related adverse events and no clinically significant laboratory results were reported. The 11 patients with severe leg pain and lower-extremity weakness who were treated with Oxiplex/SP Gel had a reduction in those symptoms at 30 days, 90 days, 6 months, and 12 months after discectomy, compared with the seven control patients who underwent surgery only. Conclusions Oxiplex/SP Gel was easy to use and safe in patients who underwent unilateral discectomy. A greater benefit in clinical outcome measures was seen over the 12-month follow-up period in gel-treated patients.

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