scholarly journals Clinical Reasoning: A 57-Year-Old Man With Stepwise Progressive Paraparesis, Sensory Loss, Urinary Retention, and Constipation

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013090
Author(s):  
Samir Alkabie ◽  
Omar Tanweer ◽  
George J. Hutton ◽  
Fernando X. Cuascut
Keyword(s):  
Cauda Equina ◽  
Inpatient Rehabilitation ◽  
Protein S ◽  
Sensory Function ◽  
Sensory Loss ◽  
Nucleic Acid Detection ◽  
Spinal Dural Arteriovenous Fistula ◽  
Limb Weakness ◽  
Hyperintense Lesion ◽  
Vein Thrombosis

We present the case of a 57-year-old man with protein S deficiency and left leg deep vein thrombosis (DVT) five years prior, who developed stepwise progressive bilateral lower limb weakness, numbness/paresthesia, gait imbalance, hesitancy of micturition, and constipation in the setting of recurrent left common femoral DVT treated with apixaban. Symptoms amplified with Valsalva, corticosteroids, and post-lumbar puncture, with longitudinally extensive mid-thoracic T2-hyperintense lesion extending to the conus associated with hazy holocord enhancement on magnetic resonance imaging (MRI), raising suspicion for spinal dural arteriovenous fistula (sDAVF). Initial digital subtraction angiography (DSA) was negative for sDAVF. However, cerebral spinal fluid (CSF) was herpes simplex virus (HSV)-2 positive, and he was treated with antiviral therapy. Unfortunately, he continued to worsen despite treatment. Repeat neuroimaging twelve months after initial presentation demonstrated persistent lower thoracic/conus lesion in addition to cauda equina enhancement and subtle dorsal T2-hypointense flow voids. We raised red flags (eg, lack of clinical prodrome, no herpetic rash, no CSF pleocytosis, and rostral extent of the lesion) that suggested the HSV2 nucleic acid detection was perhaps unrelated to the neurological syndrome. Given the high index of suspicion for sDAVF, we repeated spinal vascular imaging. Spinal MRA demonstrated dilated right dorsal perimedullary veins from T10 to T11. Repeat DSA revealed a right T10 sDAVF. Microsurgical treatment rather than embolization of the fistula was successful without complication, with significant improvement in motor, sphincter, and to a lesser extent sensory function, with residual gait imbalance after inpatient rehabilitation three weeks postoperatively.

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 Sudden-onset paraplegia in a 72-year-old male with a spinal dural arteriovenous fistula: illustrative case

2021 ◽  
Vol 2 (9) ◽  
Author(s):  
Ikenna I. Ogbu ◽  
Nikolaos Tzerakis ◽  
Zaineb Al-Shamary
Keyword(s):  
Early Recognition ◽  
Vascular Malformations ◽  
Case Reports ◽  
Cauda Equina ◽  
Sudden Onset ◽  
Sensory Loss ◽  
Illustrative Case ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulas ◽  
High Index Of Suspicion

BACKGROUND Spinal dural arteriovenous fistulas (SDAVFs) are rare vascular malformations of the spine but account for up to 80% of all vascular malformations involving the spine. Few case reports of SDAVFs have been reported in the literature, and even fewer have been described with sudden onset of symptoms. OBSERVATIONS The authors described the case of a 72-year-old male with sudden-onset bilateral paraplegia and sensory loss with subsequent inability to bear weight and an initial suspicion of cauda equina syndrome, which was eventually diagnosed as an SDAVF using magnetic resonance imaging. During open surgery, it was difficult to identify the feeder vessels. A postoperative scan showed persistence of the fistula, and the patient had to receive redo ligation with good postoperative status. LESSONS Sudden-onset paraplegia is not the typical presentation of SDAVF. All doctors need to be aware of the possibility of an acute presentation with SDAVF, especially with the high likelihood of misdiagnosis and resultant worse outcome due to treatment delays. A high index of suspicion is required to ensure early recognition as well as initiation of treatment.

Autoimmune Protein S Deficiency and Deep Vein Thrombosis after Chickenpox

1996 ◽  
Vol 75 (01) ◽  
pp. 212-213 ◽  
Author(s):  
Flora Peyvandi ◽  
Elena Faioni ◽  
Gian Alessandro Moroni ◽  
Alberto Rosti ◽  
Luigi Leo ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Protein S ◽  
Protein S Deficiency ◽  
Vein Thrombosis ◽  
S Deficiency ◽  
Deep Vein

A Protein S Deficient Family with Portal Vein Thrombosis

1985 ◽  
Vol 54 (03) ◽  
pp. 724-724 ◽  
Author(s):  
Géza Sas ◽  
György Blaskó ◽  
Iván Petrö ◽  
John H Griffin
Keyword(s):  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Protein S ◽  
Vein Thrombosis

scholarly journals Malignant isolated cortical vein thrombosis with type II protein S deficiency: a case report

BMC Neurology ◽  
2016 ◽  
Vol 16 (1) ◽  
Author(s):  
Nobuhiko Arai ◽  
Masanao Tabuse ◽  
Akiyoshi Nakamura ◽  
Hiromichi Miyazaki
Keyword(s):  
Case Report ◽  
Protein S ◽  
Type Ii ◽  
Protein S Deficiency ◽  
Cortical Vein ◽  
Vein Thrombosis ◽  
Cortical Vein Thrombosis ◽  
S Deficiency

scholarly journals Cerebral and vein thrombosis, transient protein S deficiency, and anticardiolipin antibodies

1996 ◽  
Vol 52 (1) ◽  
pp. 69-70 ◽  
Author(s):  
Gian Luigi Ricchieri ◽  
Gilberto Piuolato ◽  
Maurizio Fabbri ◽  
Giovanni M. Patrassi ◽  
Maria Teresa Sartori
Keyword(s):  
Protein S ◽  
Anticardiolipin Antibodies ◽  
Protein S Deficiency ◽  
Vein Thrombosis ◽  
S Deficiency

Protein S–K196E mutation as a genetic risk factor for deep vein thrombosis in Japanese patients

Blood ◽  
2006 ◽  
Vol 107 (4) ◽  
pp. 1737-1738 ◽  
Author(s):  
Rina Kimura ◽  
Shigenori Honda ◽  
Tomio Kawasaki ◽  
Hajime Tsuji ◽  
Seiji Madoiwa ◽  
...  
Keyword(s):  
Risk Factor ◽  
Deep Vein Thrombosis ◽  
Genetic Risk ◽  
Protein S ◽  
Japanese Patients ◽  
Genetic Risk Factor ◽  
Vein Thrombosis ◽  
Deep Vein

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 Do social factors mediate or moderate the sensory-cognitive associations in older adults in the Canadian Longitudinal Study on Aging?

2019 ◽  
Author(s):  
Anni Hämäläinen ◽  
Natalie Phillips ◽  
Walter Wittich ◽  
Paul Mick ◽  
M Kathleen Pichora-Fuller
Keyword(s):  
Longitudinal Study ◽  
Cognitive Decline ◽  
Social Factors ◽  
Pure Tone Audiometry ◽  
Sensory Function ◽  
Sensory Loss ◽  
Protective Effects ◽  
Social Variables ◽  
Cross Sectional ◽  
Age Related

Sensory and cognitive function both tend to decline with increasing age. Sensory impairments are risk factors for age-related cognitive decline and dementia. One hypothesis about sensory-cognitive associations is that sensory loss results in social isolation which, in turn, is a risk factor for cognitive decline. We tested whether social factors are associated with cognitive and sensory function, and whether sensory-cognitive associations are mediated or moderated by social factors. We used cross-sectional data from 30,029 participants in the Canadian Longitudinal Study of Aging, aged 45-85 years, who had no reported cognitive impairment or diagnosis of dementia. We found strong independent associations of self-reported social variables with hearing (pure-tone audiometry), vision (pinhole-corrected visual acuity), and executive function and weaker associations with memory. The moderating and mediating effects of social variables on sensory-cognitive associations were weak and mostly non-significant, but social factors could be slightly more important for females and older people. Partial retirement (relative to full retirement or not being retired) may have protective effects on cognition in the presence of hearing loss. These findings confirm the association between social factors and sensory and cognitive measures. However, support is weak for the hypothesis that social factors shape sensory-cognitive associations.

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