Sacral insufficiency fracture complicated by epidural haematoma and cauda equina syndrome in a patient with multiple myeloma

Background: Factor Xa inhibitors are widely used by the physicians to reduce the incidence of thrombosis in order to protect the cardiovascular function. Although complications of bleeding and spontaneous gastrointestinal sources have been reported before, there are very sporadic cases of spinal epidural haematoma causing neurological compromise. Case presentation: We report a case of spontaneous spinal epidural haematoma (SSEH) in an 85-year-old female patient treated with Rivaroxaban, a new agent to prevent the incidence of thrombo-embolic events. Anticoagulant therapy is a recognised risk factor in the development of spontaneous bleeding and haematomas. The patient presented to the emergency department with sudden onset of severe back pain in the lumbar spine associated with paraplegia in the lower limbs. Magnetic resonance imaging (MRI) of the spine demonstrated a SSEH from T12 to L5 affecting the cauda equina. Rivaroxaban was discontinued and the patient was monitored as an inpatient. There was gradual improvement in the symptoms of the lower limbs. Conclusion: This rare condition of incomplete cauda equina syndrome due to Rivaroxaban therapy has not been reported previously. Clinicians must have a high index of suspicion in patients on regular anti-coagulation regimen.

Download Full-text

Traumatic extradural lumbar haematoma due to a pathological metastatic vertebral body fracture L3. Case report and review of the literature

Romanian Neurosurgery ◽

10.1515/romneu-2016-0036 ◽

2016 ◽

Vol 30 (2) ◽

pp. 237-240

Author(s):

Daniel Balasa ◽

Gabriela Butoi ◽

Radu Baz ◽

Anca Hancu

Keyword(s):

Cauda Equina Syndrome ◽

Cauda Equina ◽

Epidural Haematoma ◽

Metastatic Tumor ◽

Neurological Status ◽

Extradural Haematoma ◽

Spinal Epidural Haematoma ◽

Body Fracture ◽

Traumatic Fracture ◽

Spinal Epidural

Abstract Spinal epidural haematoma (SEH) is a rare entity. We present the case of a 45 years old patient with lumbar epidural hematoma produced by a L3 vertebral tumoral (metastatic) fracture. Neurological status: cauda equina syndrome with sphincterian deficits, incomplete paraplegia (Frankel C), with neurological level L1. Emergency surgery was performed (L3-L2-bilateral laminectomy, L1 left laminectomy, posterior stabilization L2-L4 by titan screws) offering the possibility to progressive motor, sensitive and sphincterian deficites recovery. Abbreviations: Computer Tomography-CT, Magnetic resonance Imaging-MRI, Spinal epidural haematoma-SEH, Visual analogue scale of pain-VAS. Conclusion: We present a patient with a compressive subacute extradural haematoma, due to a traumatic fracture on a vertebral metastatic tumor who produced cauda equina syndrome. Surgical emergency intervention was mandatory for a good neurological outcome.

Download Full-text

Postoperative Spinal Epidural Haematoma Causing Cauda Equina Syndrome: Case Report

The Annals of Clinical and Analytical Medicine ◽

10.4328/jcam.2480 ◽

2013 ◽

Vol 4 (Supplement 4) ◽

Keyword(s):

Case Report ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Epidural Haematoma ◽

Spinal Epidural Haematoma ◽

Spinal Epidural

Download Full-text

Cauda Equina Syndrome as the Initial Presentation of Concurrent Plasmacytoma and Multiple Myeloma

Cureus ◽

10.7759/cureus.12888 ◽

2021 ◽

Author(s):

Alexandra Pisklakova ◽

Christian Almanzar ◽

Jan - Paul Sambataro ◽

Omar Ansari ◽

Faiza Manji

Keyword(s):

Multiple Myeloma ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Initial Presentation

Download Full-text

Cauda Equina Syndrome due to Multiple Myeloma: A Case Report

Bangladesh Journal of Neuroscience ◽

10.3329/bjn.v30i1.57367 ◽

2014 ◽

Vol 30 (1) ◽

pp. 57-61

Author(s):

Md Rashedul Islam ◽

Tanbin Rahman ◽

Rumana Habib ◽

Aminur Rahman ◽

Nirmalendu Bikash Bhowmic ◽

...

Keyword(s):

Multiple Myeloma ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Vertebral Compression Fractures ◽

Ct Guided ◽

Unexplained Weight Loss ◽

Uncommon Presentation ◽

Cauda Equina Compression ◽

Bone Marrow Study

Cauda equina compression following vertebral compression fractures or vertebral plasmacytomas is relatively uncommon presentation of multiple myeloma. Here we describe a case of cauda equina syndrome due to multiple myeloma in an elderly Bangladeshi male who presented with difficulty in walking, urinary complaints & unexplained weight loss. CT guided FNAC from lesion of spine, bone marrow study, skeletal survey, MRI of spine & immune electrophoresis confirmed the diagnosis of multiple myeloma. We treated the patient with radiotherapy, dexamethasone, antimyeloma therapy, physiotherapy & bisphosphonates in collaboration with hematologists & neurosurgeons. He showed significant improvement both clinically & biochemically in the follow up. Bangladesh Journal of Neuroscience 2014; Vol. 30 (1): 57-61

Download Full-text

Successful BCMA CAR-T Therapy for Multiple Myeloma With Central Nervous System Involvement Manifesting as Cauda Equina Syndrome—A Wandering Road to Remission

Frontiers in Oncology ◽

10.3389/fonc.2021.755584 ◽

2021 ◽

Vol 11 ◽

Author(s):

Yiyun Wang ◽

Linqin Wang ◽

Yifan Zeng ◽

Ruimin Hong ◽

Cheng Zu ◽

...

Keyword(s):

Central Nervous System ◽

Multiple Myeloma ◽

T Cells ◽

Nervous System ◽

T Cell ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Cns Involvement ◽

Car T Cells ◽

Car T

Multiple myeloma (MM) with central nervous system (CNS) involvement is rare with only 1% incidence. So far, there is no standard or effective treatment for CNS MM, and the expected survival time is fewer than 6 months. Here, we report a case of MM with CNS involvement presented with cauda equina syndrome (CES) who achieved complete remission after anti-B-cell maturation antigen (BCMA) chimeric antigen receptor T (CAR-T) cell therapy (Chictr.org.cn, ChiCTR1800017404). The expansion of BCMA CAR-T cells was observed in both peripheral blood (PB) and cerebrospinal fluid (CSF). The CAR-T cells peaked at 2.4 × 106/l in CSF at day 8 and 4.1 × 109/l in PB at day 13. The peak concentration of interleukin (IL)-6 in CSF was detected 3 days earlier, and almost five times higher than that in PB. Next, morphological analysis confirmed the elimination of nucleated cells in CSF 1 month after CAR-T cell treatment from 300 cells/μl, and the patient achieved functional recovery with regressed lesion shown in PET-CT. The case demonstrated that BCMA CAR-T cells are effective and safe in this patient population.

Download Full-text