scholarly journals ‘Scan-negative’ cauda equina syndrome: what to do when there is no neurosurgical cause

2021 ◽  
pp. practneurol-2020-002830
Author(s):  
Ingrid Hoeritzauer ◽  
Biba Stanton ◽  
Alan Carson ◽  
Jon Stone
Keyword(s):  
Differential Diagnosis ◽  
Clinical Features ◽  
Acute Pain ◽  
Small Proportion ◽  
Neurological Disorder ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Common Presentation ◽  
Cauda Equina Compression ◽  
Functional Neurological Disorder

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.

scholarly journals “Scan-negative” cauda equina syndrome: A prospective cohort study

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011154
Author(s):  
Ingrid Hoeritzauer ◽  
Alan Carson ◽  
Patrick Statham ◽  
Jalesh N. Panicker ◽  
Voula Granitsiotis ◽  
...  
Keyword(s):  
Prospective Study ◽  
Clinical Features ◽  
Neurological Disorder ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Clinical Signs ◽  
Structured Interview ◽  
Presenting Symptoms ◽  
Significant Difference ◽  
Functional Neurological Disorder

Objective:To describe clinical features relevant to diagnosis, mechanism and aetiology in patients with ‘scan-negative’ cauda equina syndrome (CES).Methods:We carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery centre comprising semi-structured interview and questionnaires investigating presenting symptoms, neurological examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress and disability.Results:198 patients presented consecutively over 28 months. 47 were diagnosed with ‘scan-positive’ CES (mean age 48yrs, 43% female). 76 ‘mixed’ category patients had nerve root compression/displacement without CES compression, (mean age 46yrs, 71% female) and 61 patients had ‘scan-negative’ CES (mean age 40yrs, 77% female). An alternative neurological cause of CES emerged in 14/198 patients during admission and 4/151 patients with mean duration 25 months follow up.Patients with ‘scan-negative’ CES had more positive clinical signs of a functional neurological disorder (11%‘scan positive’ CES v. 34%mixed and 68%‘scan-negative’, p<0.0001), were more likely to describe their current back pain as ‘worst ever’ (41% vs. 46% and 70%, p=0.005) and have symptoms of a panic attack at onset (37% vs. 57% and 70%, p=0.001). Patients with ‘scan positive’ CES were more likely to have reduced/absent bilateral ankle jerks (78% ‘vs. 30% and 12%, p=<0.0001). There was no significant difference between groups in the frequency of reduced anal tone and urinary retention.Conclusions:The first well phenotyped, prospective study of ‘scan-negative’ CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurological disorder may be relevant.

scholarly journals Is scan‐negative cauda equina syndrome a functional neurological disorder? A pilot study

2020 ◽  
Vol 27 (7) ◽  
pp. 1336-1342
Author(s):  
L. L. Gibson ◽  
L. Harborow ◽  
T. Nicholson ◽  
D. Bell ◽  
A. S. David
Keyword(s):  
Pilot Study ◽  
Neurological Disorder ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Functional Neurological Disorder

A prospective study of the role of bladder scanning and post-void residual volume measurement in improving diagnostic accuracy of cauda equina syndrome

2020 ◽  
Vol 102-B (6) ◽  
pp. 677-682
Author(s):  
Galateia Katzouraki ◽  
Akbar Jaleel Zubairi ◽  
Oded Hershkovich ◽  
Michael P. Grevitt
Keyword(s):  
Risk Stratification ◽  
Prospective Study ◽  
Clinical Assessment ◽  
Predictive Value ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Cost Savings ◽  
Volume Measurement ◽  
Cauda Equina Compression ◽  
Mri Scans

Aims Diagnosis of cauda equina syndrome (CES) remains difficult; clinical assessment has low accuracy in reliably predicting MRI compression of the cauda equina (CE). This prospective study tests the usefulness of ultrasound bladder scans as an adjunct for diagnosing CES. Methods A total of 260 patients with suspected CES were referred to a tertiary spinal unit over a 16-month period. All were assessed by Board-eligible spinal surgeons and had transabdominal ultrasound bladder scans for pre- and post-voiding residual (PVR) volume measurements before lumbosacral MRI. Results The study confirms the low predictive value of ‘red flag’ symptoms and signs. Of note ‘bilateral sciatica’ had a sensitivity of 32.4%, and a positive predictive value (PPV) of only 17.2%, and negative predictive value (NPV) 88.3%. Use of a PVR volume of ≥ 200 ml was a demonstrably more accurate test for predicting cauda equina compression on subsequent MRI (p < 0.001). The PVR sensitivity was 94.1%, specificity 66.8%, PPV 29.9% and NPV 98.7%. The PVR allowed risk-stratification with 13% patients deemed ‘low-risk’ of CES. They had non-urgent MRI scans. None of the latter scans showed any cauda equina compression (p < 0.006) or individuals developed subsequent CES in the intervening period. There were considerable cost-savings associated with the above strategy. Conclusion This is the largest reported prospective evaluation of suspected CES. Use of the PVR volume ≥ 200 ml was considerably more accurate in predicting CES. It is a useful adjunct to conventional clinical assessment and allows risk-stratification in managing suspected CES. If adopted widely it is less likely incomplete CES would be missed. Cite this article: Bone Joint J 2020;102-B(6):677–682.

A Polyostotic Paget’s Disease Involving Lumbar Spine Presenting with Cauda Equina Syndrome: An Unusual Entity

2021 ◽  
Vol 11 (10) ◽  
Author(s):  
Shailesh Hadgaonkar ◽  
Shaunak Patwardhan ◽  
Pramod Bhilare ◽  
Parag Sancheti ◽  
Ashok Shyam
Keyword(s):  
Lumbar Spine ◽  
Neurological Deficit ◽  
Cauda Equina Syndrome ◽  
Indian Subcontinent ◽  
Paget’S Disease ◽  
Cauda Equina ◽  
Neurological Complications ◽  
Paget's Disease ◽  
Metabolic Bone ◽  
Cauda Equina Compression

Introduction:Paget’s disease of bone (PDB) is a metabolic bone disease presenting as polyostotic or monostotic lesions of the spine. Although common in the Anglo-Saxon population, it is rare on the Indian subcontinent. Neurological complications though infrequent can be severe in pagetic spine. Case Report:We report a case of a polyostotic variant of PDB involving lumbar spine (L2 vertebrae), iliac bones, and femur presenting as chronic low back pain and neurological deficit, i.e., cauda equina syndrome. On initial workup, a diagnosis of PDB was made and given cauda equina compression with neurological deficit, posterior spinal decompression, and biopsy was performed. The histopathological evaluation confirmed the diagnosis and the patient was treated with bisphosphonates for 6 months, along with serial monitoring of alkaline phosphatase levels. Conclusion:Through this case report, we hope to emphasize that PDB should be considered as a possible cause of neurological symptoms at presentation, especially in elderly patients. Also furthermore, early surgical intervention followed by bisphosphonates therapy can lead to favorable outcomes in such patients. Keywords:Polyostotic, Paget’s disease, cauda equine syndrome, lumbar spine.

Limited sequence MRI to improve standards of care for suspected cauda equina syndrome

2020 ◽  
Vol 102-B (4) ◽  
pp. 501-505 ◽  
Author(s):  
Ramal Gnanasekaran ◽  
Nicholas Beresford-Cleary ◽  
Tariq Aboelmagd ◽  
Karim Aboelmagd ◽  
Daniel Rolton ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Standards Of Care ◽  
Safety And Efficacy ◽  
Cauda Equina Compression ◽  
Mri Scans ◽  
Symptoms And Signs ◽  
Limited Sequence ◽  
Musculoskeletal Radiologist ◽  
Rule Out

Aims Early cases of cauda equina syndrome (CES) often present with nonspecific symptoms and signs, and it is recommended that patients undergo emergency MRI regardless of the time since presentation. This creates substantial pressure on resources, with many scans performed to rule out cauda equina rather than confirm it. We propose that compression of the cauda equina should be apparent with a limited sequence (LS) scan that takes significantly less time to perform. Methods In all, 188 patients with suspected CES underwent a LS lumbosacral MRI between the beginning of September 2017 and the end of July 2018. These images were read by a consultant musculoskeletal radiologist. All images took place on a 3T or 1.5T MRI scanner at Stoke Mandeville Hospital, Aylesbury, UK, and Royal Berkshire Hospital, Reading, UK. Results The 188 patients, all under the age of 55 years, underwent 196 LS lumbosacral MRI scans for suspected CES. Of these patients, 14 had cauda equina compression and underwent emergency decompression. No cases of CES were missed. Patients spent a mean 9.9 minutes (8 to 10) in the MRI scanner. Conclusion Our results suggest that a LS lumbosacral MRI could be used to diagnose CES safely in patients under the age of 55 years, but that further research is needed to assess safety and efficacy of this technique before changes to existing protocols can be recommended. In addition, work is needed to assess if LS MRIs can be used throughout the spine and if alternative pathology is being considered. Cite this article: Bone Joint J 2020;102-B(4):501–505.

Chronic Posttraumatic Lumbar Intradural Arachnoid Cyst with Cauda Equina Compression: Case Report

Neurosurgery ◽  
1987 ◽  
Vol 20 (4) ◽  
pp. 636-638 ◽  
Author(s):  
Mario Zuccarello ◽  
Gerald Powers ◽  
William D. Tobler ◽  
Raymond Sawaya ◽  
Simon Z. Hakim
Keyword(s):  
Case Report ◽  
Clinical Features ◽  
Arachnoid Cyst ◽  
Unusual Case ◽  
Cauda Equina ◽  
Correct Interpretation ◽  
Radiological Findings ◽  
Cauda Equina Compression

Abstract An unusual case of a chronic posttraumatic lumbar intradural arachnoid cyst causing compression of the cauda equina is reported. The etiological, pathological, and clinical features are discussed. Emphasis is placed on the importance of a correct interpretation of radiological findings.

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