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 Neurology (General Neurology)

2015 ◽  
Vol 42 (S1) ◽  
pp. S28-S28
Author(s):  
A Alkhotani ◽  
N Alrishi ◽  
M Alhalabi
Keyword(s):  
Gastroesophageal Junction ◽  
Cauda Equina ◽  
Leptomeningeal Carcinomatosis ◽  
Leg Pain ◽  
Urine Retention ◽  
Gastroesophageal Junction Cancer ◽  
Facial Diplegia ◽  
Leg Weakness ◽  
Spinal Roots ◽  
Cranial Neuropathies

Background: Leptomeningeal Carcinomatosis (LMC) is defined as a diffuse or multifocal malignant infiltration of the Pia matter and arachnoid membrane. It is clinically diagnosed in 5-10% of all cancer patients. The most commonly reported cancers associated with LMC are breast, lung and hematological malignancies. Patients with LMC commonly present with multifocal neurological symptoms. Symptoms are related to increase intracranial pressure, hemispheric dysfunction, cranial neuropathies and spinal roots dysfunction. We report a case of LMC secondary to Gastroesophageal junction cancer present initially with Cauda equine syndrome. Methods: A 51 year old male patient with adenocarcinoma of Gastroesophageal junction who underwent surgical resection, chemotherapy and radiation therapy. Nine month after diagnosis he presented with left leg pain, mild weakness and saddle area numbness. Initial radiological examination 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. Results: MRI with and without contrast showed diffuse enhancement of leptomeninges surrounding the brain, spinal cord and Cauda equine extending to the nerve roots. Cerebrospinal fluid cytology was positive for malignant cells. Conclusion: In cancer patient with Cauda equina syndrome and absence of structural lesion on imaging, LMC should be considered.

scholarly journals 1499 The Statistical Value of Different Clinical Characteristics in Evaluation of Suspected Cauda Equina Syndrome

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
W Levitt ◽  
B Kamalakannan ◽  
Y Leung
Keyword(s):  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Pain Sensitivity ◽  
Cauda Equina ◽  
Leg Pain ◽  
Statistical Association ◽  
Mri Findings ◽  
Leg Weakness ◽  
Red Flag ◽  
One Year

Abstract Introduction Cauda Equina Syndrome(CES) is a potentially disabling condition caused by compression of the thecal sac in the lumbar spine. Traditional teaching suggests red flags include back pain, sciatica, saddle anaesthesia and bladder disturbance. Current guidelines from the British Association of Spinal Surgeons recommend prompt investigation with MRI should these symptoms be present. Method A retrospective electronic case note review was undertaken from a one-year period to identify patients referred to the on call orthopaedic team with suspected CES and were investigated with MRI. Notes were reviewed for the presence of each clinical characteristic and correlated with MRI findings. Results 334 referrals underwent urgent MRI with 25 scans showing CES. Poor statistical association was observed with unilateral leg pain (sensitivity 0.28, specificity 0.48), back pain (sensitivity 0.92, specificity 0.13) and bladder dysfunction (sensitivity 0.72, specificity 0.36). Much closer statistical association was seen with bilateral leg pain (sensitivity 0.6, specificity 0.7, OR 5.03, 95% CI 2.16-11.68, p0.0002), leg weakness (sensitivity 0.68, specificity of 0.72, OR 5.35, 95% CI 2.23-12.85, p0.0002), leg sensory deficit (sensitivity 0.72, specificity 0.60, OR 3.79, 95% CI 1.54-9.36, p0.004) and altered perianal sensation (sensitivity 0.6, specificity 0.67, OR 3.03, 95% CI 1.31-6.99, p 0.009) Conclusions The diagnostic accuracy for some conventional red flag characteristics in CES is low. In our series back pain, unilateral sciatica and bladder disturbance showed low predictive value while bilateral sciatica, saddle anesthesia and lower limb sensorimotor deficits showed closer association and therefore should be closely evaluated for when reviewing such patients.

Poster 399: Cauda Equina Syndrome Due to Leptomeningeal Carcinomatosis: A Case Report and Literature Review

PM&R ◽  
2010 ◽  
Vol 2 ◽  
pp. S175-S175
Author(s):  
Michelle Weiner ◽  
Kresimir Banovac ◽  
Jasmine Martinez-Barrizonte
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Leptomeningeal Carcinomatosis

scholarly journals Unilateral Cauda Equina Syndrome Due to Cancer Metastasis Diagnosed with Electromyography: A Case Report

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1370
Author(s):  
Chan-Hee Park ◽  
Eunhee Park ◽  
Tae-Du Jung
Keyword(s):  
Lumbar Spine ◽  
Cauda Equina Syndrome ◽  
Cancer Metastasis ◽  
Proper Time ◽  
Cauda Equina ◽  
B Cell Lymphoma ◽  
Leg Pain ◽  
Muscle Membrane ◽  
The Right ◽  
Hands And Feet

Background: Typical cauda equina syndrome (CES) presents as low back pain, bilateral leg pain with motor and sensory deficits, genitourinary dysfunction, saddle anesthesia and fecal incontinence. In addition, it is a neurosurgical emergency, which is essential to diagnose as soon as possible, and needs prompt intervention. However, unilateral CES is rare. Here, we report a unique case of a patient who had unilateral symptoms of CES due to cancer metastasis and was diagnosed through electromyography. Methods: A 71-year-old man with diffuse large B cell lymphoma (DLBCL) suffered from severe pain, motor weakness in the right lower limb and urinary incontinence, and hemi-saddle anesthesia. It was easy to be confused with lumbar radiculopathy due to the unilateral symptoms. Lumbar spine magnetic resonance imaging (MRI) showed suspected multifocal bone metastasis in the TL spine, including T11-L5, the bilateral sacrum and iliac bones, and suspected epidural metastasis at L4/5, L5/S1 and the sacrum. PET CT conducted after the third R-CHOP showed residual hypermetabolic lesions in L5, the sacrum, and the right presacral area. Results: Nerve conduction studies (NCS) revealed peripheral neuropathy in both hands and feet. Electromyography (EMG) presented abnormal results indicating development of muscle membrane instability following neural injury, not only on the right symptomatic side, but also on the other side which was considered intact. Overall, he was diagnosed with cauda equina syndrome caused by DLBCL metastasis, and referred to neurosurgical department. Conclusions: Early diagnosis of unilateral CES may go unnoticed due to its unilateral symptoms. Failure to perform the intervention at the proper time can impede recovery and leave permanent complications. Therefore, physicians need to know not only the typical CES, but also the clinical features of atypical CES when encountering a patient, and further evaluation such as electrodiagnostic study or lumbar spine MRI have to be considered.

scholarly journals Cauda equina syndrome due to leptomeningeal carcinomatosis: a medical dilemma

2020 ◽  
Vol 13 (2) ◽  
pp. e232297
Author(s):  
Leila Izadi Firouzabadi ◽  
Paul Mead ◽  
Jonathan Berry ◽  
Sheharyar Hanif
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Leptomeningeal Carcinomatosis

Percutaneous Endoscopic Lumbar Discectomy for Treating Cauda Equina Syndrome Due To Lumbar Disc Herniation

2021 ◽  
Author(s):  
Hai-Chao He ◽  
Xiao-qiang LV ◽  
Yong-Jin Zhang
Keyword(s):  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Endoscopic Lumbar Discectomy

Abstract Background In recent decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, there is little literature on the use of percutaneous endoscopic lumbar discectomy (PELD) to treat cauda equina syndrome (CES) due to LDH. This study aims to evaluate the feasibility and clinical efficacy of PELD for treating CES caused by disc herniation, and as well as to report some technical strategies. Methods Between October 2012 and April 2018, 15 patients with CES caused by LDH at the early and intermediate stages of Shi’s classification were selected as the subjects of study, and underwent PELD. All patients were followed up for at least two years. The patients’ back pain and leg pain were evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Patient satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively and at 3 days, 3 months, 6 months and the last follow-up. Results The VAS score for back pain, leg pain and ODI score significantly decreased from preoperatively scores of 6.67 ± 1.05, 7.13 ± 1.19 and 62.0 ± 6.85 respectively, to postoperatively cores of 1.80 ± 0.41, 1.47 ± 0.52 and 12.93 ± 1.03 at the last follow-up postoperatively. These postoperative scores were all significantly different compared with preoperative scores (P < 0.01). According to the modified MacNab outcome scale, 86.67% of these patients had excellent and good outcomes at the final follow-up. Complications included one patient with cerebrospinal fluid leakage and one patient who developed recurrent herniation; the latter patient finally achieved satisfactory results after reoperation. Conclusion PELD could be used as an alternative surgical method for the treatment of CES due to LDH in properly selected cases and appropriate patient selection. However, the operator should pay attention to foraminoplasty to enlarge the working space.

scholarly journals Conus medullaris and cauda equina syndrome as a result of traumatic injuries: management principles

2004 ◽  
Vol 16 (6) ◽  
pp. 1-23 ◽  
Author(s):  
James S. Harrop ◽  
Gabriel E. Hunt ◽  
Alexander R. Vaccaro
Keyword(s):  
Neurological Disorders ◽  
Cauda Equina Syndrome ◽  
Treatment Options ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Leg Pain ◽  
Terminal Portion ◽  
Traumatic Injuries ◽  
Precise Understanding ◽  
Disc Herniations

Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are complex neurological disorders that can be manifested through a variety of symptoms. Patients may present with back pain, unilateral or bilateral leg pain, paresthesias and weakness, perineum or saddle anesthesia, and rectal and/or urinary incontinence or dysfunction. Although patients typically present with acute disc herniations, traumatic injuries at the thoracolumbar junction at the terminal portion of the spinal cord and cauda equina are also common. Unfortunately, a precise understanding of the pathophysiology and optimal treatments, including the best timing of surgery, has yet to be elucidated for either traumatic CES or CMS. In this paper the authors review the current literature on traumatic conus medullaris and cauda equina injuries and available treatment options.

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.

Postoperative cauda equina syndrome in patients undergoing single-level lumbar microdiscectomy

2005 ◽  
Vol 19 (2) ◽  
pp. 1-5 ◽  
Author(s):  
Vassilios Dimopoulos ◽  
Kostas N. Fountas ◽  
Theofilos G. Machinis ◽  
Carlos Feltes ◽  
Induk Chung ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
De Novo ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Clinical Findings ◽  
Magnetic Resonance Images ◽  
Single Level ◽  
Lumbar Microdiscectomy ◽  
First Case ◽  
Intraoperative Electrophysiological Monitoring

Cauda equina syndrome is a well-documented complication of uneventful lumbar microdiscectomy. In the vast majority of cases, no radiological explanation can be obtained. In this paper, the authors report two cases of postoperative cauda equina syndrome in patients undergoing single-level de novo lumbar microdiscectomy in which intraoperative electrophysiological monitoring was used. In both patients, the amplitudes of cortical and subcortical intraoperative somatosensory evoked potentials (SSEPs) abruptly decreased during discectomy and foraminotomy. In the first patient, a slow, partial improvement of SSEPs was observed before the end of the operation, whereas no improvement was observed in the second patient. In the first case, clinical findings consistent with cauda equina syndrome were seen immediately postoperatively, whereas in the second one the symptoms developed within 1.5 hours after the procedure. Postoperative magnetic resonance images obtained in both patients, and a lumbar myelogram obtained in the second one revealed no signs of conus medullaris or nerve root compression. Both patients showed marked improvement after an intense course of rehabilitation. The authors' findings support the proposition that intraoperative SSEP monitoring may be useful in predicting the development of cauda equina syndrome in patients undergoing lumbar microdiscectomy. Nevertheless, further prospective clinical studies are necessary for validation of these findings.

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