scholarly journals Late presentation of a cauda equina lesion with a vulval abscess: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Chanil Deshan Ekanayake ◽  
Deepal Weerasekera ◽  
Dilini Dissanayake ◽  
Ranga Wickramarachchi ◽  
Saman Pushpakumara ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Late Presentation ◽  
Surgical Decompression ◽  
Lower Limbs ◽  
Sensory Loss ◽  
Postoperative Rehabilitation ◽  
Indwelling Catheter ◽  
Distended Bladder ◽  
Tract Infections

Abstract Background Cauda equina syndrome is a rare clinical condition that requires prompt diagnosis and timely surgical decompression with postoperative rehabilitation to prevent devastating complications. Case presentation A 55-year-old Sinhalese woman presented with a vulval abscess, with a history of involuntary leakage of urine for the last 7 years. Her sexual activity has been compromised due to coital incontinence, and she had also been treated for recurrent urinary tract infections during the last 7 years. On examination, a distended bladder was found. Neurological examination revealed a saddle sensory loss of S2–S4 dermatomes. There was no sensory loss over the lower limbs. Bladder sensation was absent, but there was some degree of anal sphincter tone. Motor functions and reflexes were normal in the limbs. Magnetic resonance imaging revealed L5–S1 spondylolisthesis. Ultrasound imaging confirmed the finding of a distended bladder, in addition to bilateral hydroureters with hydronephrosis. An incision and drainage with concomitant intravenous antibiotics were started for the vulval abscess. An indwelling catheter was placed to decompress the bladder and to reduce vulval excoriations due to urine. Bilateral ureteric stenting was performed later for persistent hydronephrosis and hydroureter despite an empty bladder. Conclusion This is a tragic case that illustrates the devastating long-term sequelae that ensues if cauda equina syndrome is left undiagnosed. It reiterates the importance of prompt referral and surgical decompression.

scholarly journals Cauda equina syndrome due to Factor Xa inhibitor (Rivaroxaban): Case report and review of literature

2020 ◽  
Vol 7 (1) ◽  
pp. 7
Author(s):  
SR Gowda ◽  
PJ O’Hagan ◽  
JT Griffiths
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Factor Xa ◽  
Epidural Haematoma ◽  
Sudden Onset ◽  
Lower Limbs ◽  
Spontaneous Bleeding ◽  
Gradual Improvement ◽  
Spinal Epidural Haematoma ◽  
Spinal Epidural

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.

scholarly journals Thoracic myelopathy secondary to multi-level ossification of the ligamentum flavum in an Asian patient

2017 ◽  
Vol 4 (3) ◽  
pp. 46
Author(s):  
Chiara J Chong ◽  
Wan Tin Lim
Keyword(s):  
Back Pain ◽  
Ligamentum Flavum ◽  
Cauda Equina ◽  
Central Canal ◽  
Sensory Function ◽  
Lower Limbs ◽  
Sensory Loss ◽  
Thoracic Myelopathy ◽  
Limb Weakness ◽  
Canal Stenosis

Thoracic myelopathy occurs less frequently than lumbar myelopathy. There are several causes of thoracic myelopathy of which ossification of the ligamentum flavum (OLF) is one. OLF has several unique features, arising posteriorly and causing proprioceptive issues first before extending to cause motor and sensory loss. We present a case of a 58-year-old gentleman with a six-month history of progressive lower limb weakness, numbness, back pain and recurrent falls due to OLF. Magnetic resonance and computed tomography imaging revealed extensive thoracic OLF and concomitant facet hypertrophy involving T6-7, T7-8, T9-10, T10-11 and L1-2. Severe central canal stenosis and L1-2 cauda equina root compression were also seen on radiological imaging. The patient developed sphincter disturbance during his admission and had difficulty passing urine. He underwent physiotherapy but was only able to sit and stand with the help of a walking frame at best. He did not regain motor or sensory function in his lower limbs although his back pain improved. Surgical decompression is associated with good neurological outcomes in OLF. Despite this, our patient declined surgery and opted for conservative therapy instead. We wish to highlight a rare case of thoracic myelopathy and the potentially irreversible neurological deterioration that occurs if there is no early surgical intervention.

scholarly journals GELFOAM INDUCED CAUDA EQUINA SYNDROME: A CASE REPORT WITH REVIEW OF LITERATURE

2020 ◽  
pp. 1-3
Author(s):  
Nazim Mughal ◽  
Deepankar Mishra ◽  
Ajay Srivastava ◽  
Nikhat Naaz
Keyword(s):  
Spinal Surgery ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Neurological Complications ◽  
Lumbar Discectomy ◽  
Lower Limbs ◽  
Gelatin Sponge ◽  
Review Of Literature ◽  
Hemostatic Agents ◽  
Dural Sac

Gelatin sponge (Gelfoam) is quite often used for haemostasis during spine surgery. However due to its property of osmotic expansion after coming in contact with blood, it has the potential to cause serious complications as a result of compression of nearby vital neurological tissues. We report a case of cauda equina syndrome due to retained Gelfoam during spinal surgery. A 35 year old female patient presented with complaints of pain and numbness in lower limbs for 5 months. MRI was suggestive of disc herniation at L4/L5. Lumbar discectomy was done and gelfoam was used for haemostasis. However, patient developed post-operative neurological complications suggestive of cauda equina syndrome. MRI showed gelfoam induced compression of dural sac. Gelfoam removal was done after which marked improvement in symptoms was observed. Conclusion: Hemostatic agents like Gelfoam which are often used during surgeries have the potential to cause compression of vital structures. Therefore, these should be removed once haemostatic control is accomplished and if it is to be retained, prompt post operatively monitoring is essential.

Does Early Surgical Decompression in Cauda Equina Syndrome Improve Bladder Outcome?

Spine ◽  
2015 ◽  
Vol 40 (8) ◽  
pp. 580-583 ◽  
Author(s):  
Nisaharan Srikandarajah ◽  
Matthew Alexander Boissaud-Cooke ◽  
Simon Clark ◽  
Martin John Wilby
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Surgical Decompression

Cauda equina syndrome secondary to an absent inferior vena cava managed with surgical decompression

2012 ◽  
Vol 16 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Mayshan Ghiassi ◽  
Mahan Ghiassi ◽  
Elyne Kahn ◽  
Luke Tomycz ◽  
Michael Ayad ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Cauda Equina Syndrome ◽  
Inferior Vena ◽  
Cauda Equina ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Surgical Decompression ◽  
Steroid Administration ◽  
Initial Improvement ◽  
Full Neurological Recovery

The authors report on the case of a 24-year-old man who presented with back pain and radiculopathy due to epidural venous engorgement in the setting of a congenitally absent inferior vena cava. Despite initial improvement after steroid administration, the patient's health ultimately declined over a period of weeks, and signs and symptoms of cauda equina syndrome manifested. Lumbar decompression was performed and involved coagulation and resection of the compressive epidural veins. No complications occurred, and the patient made a full neurological recovery.

scholarly journals Management of Cauda Equina Syndrome: NHS Staff Perceptions in a DGH

2020 ◽  
Vol 4 (2) ◽  
pp. 1-10
Author(s):  
G Taylor
Keyword(s):  
Cauda Equina Syndrome ◽  
Empirical Studies ◽  
Cauda Equina ◽  
Nominal Group Technique ◽  
Lower Limbs ◽  
Nominal Group ◽  
Poor Correlation ◽  
Mri Findings ◽  
Staff Perceptions ◽  
Validated Questionnaire

Objective: Cauda Equina Syndrome (CES) is a challenging condition to diagnose due to such variability in clinical features and poor correlation with MRI findings. It requires surgery within hours to avoid damage to the bowel, bladder, sexual organs and lower limbs. There are empirical studies exploring patients’ perspectives of having CES, however, there is no literature to review NHS staff perceptions of managing this neurosurgical emergency. The aim is to explore perceptions of senior clinical staff who commonly manage patients with suspected CES in secondary care within the Emergency Department (ED) and Trauma and Orthopaedics (T&O) to improve the management of CES. The main objective is to identify barriers to successful management and possible solutions to improve care. Methods: A self-administered non-validated questionnaire was designed to identify barriers experienced and potential solutions. In addition, a Nominal Group Technique (NGT) was used to gain a greater insight. The qualitative data obtained was analysed by thematic analysis. Results: The questionnaire generated a 73% response rate. Six senior clinicians attended the NGT with representation from the three clinical specialities; ED, T&O and Advanced Physiotherapy Practitioner (APP). The challenges and potential solutions were categorised into themes and subthemes. The barriers highlighted included; staff confidence in clinical diagnosis; fear of litigation and inter-professional relations; patient psychosocial factors, expectations and comorbidities; lack of agreed local pathway. The solutions raised include; staff training; standardising local/national pathway; access to daily Magnetic Resonance Imaging (MRI) slots. Conclusion: Patient safety and accurate diagnosis of CES is at the forefront of decision-making despite organisation barriers and limitations of existing pathways. A shift away from admission to expedite an urgent MRI requires a change to traditional clinical practice and expectations. In times of rising pressures and financial constraints, collaborative working is essential to implement and sustain the required changes highlighted in this study.

scholarly journals Spondylitis Presenting With Cauda Equina Syndrome in a 12 Year Old Boy

2020 ◽  
Vol 28 (1) ◽  
pp. 119-122
Author(s):  
Sukriti Das ◽  
Musannah Ashfaq ◽  
Kaniz Fatema Ishrat Jahan ◽  
Shamsul Islam Khan ◽  
Rakibul Islam ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Muscle Power ◽  
Cauda Equina ◽  
Surgical Excision ◽  
Lower Limbs ◽  
High Dose ◽  
Medical College ◽  
Bladder Control ◽  
History Of ◽  
Antibiotic Regime

A 12-year-old boy presented with a 2-week history of low back pain and 10-day history of weakness of the lower limbs,5-day history of inability to pass urine. An MRI scan of the lumbar spine showed dehiscent lamina of L5,S1 and an epidural abscess. He was admitted to hospital and treated with a high dose of IV antibiotics followed by radical surgical excision of the lesion. Histopathology showed features of abscess. He eventually recovered bowel and bladder control and regained muscle power in the lower limbs. Infection is not a common cause of cauda equina syndrome. Aggressive surgical treatment combined with a prolonged antibiotic regime is recommended to achieve a satisfactory result. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 119-122

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