scholarly journals Guillain-Barré syndrome and Low back pain: two cases and literature review

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 503-508
Author(s):  
Xianjun Ding ◽  
Hong Jiang ◽  
Xingyue Hu ◽  
Hong Ren ◽  
Huaying Cai
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina ◽  
Guillain Barre Syndrome ◽  
Low Back ◽  
Mri Features ◽  
Prominent Symptom ◽  
Guillain Barré Syndrome ◽  
Lumbar Mri ◽  
Guillain Barré

AbstractPurpose. To describe the clinical, electrophysiological, and lumbar magnetic resonance imaging (MRI) features of two cases of atypical Guillain-Barré syndrome (GBS). Methods We reported two GBS variant cases with initial and prominent symptoms of low back pain. We analysed their clinical, electrophysiological, and lumbar MRI features. Results Two patients with GBS reported low back pain as the initial and prominent symptom, which was not accompanied by limb weakness. The electrophysiological study showed abnormal F-waves in the common peroneal and tibial nerves, and acute polyradiculoneuropathy in the cauda equina. Examination of the cerebrospinal fluid (CSF) showed albuminocytologic dissociation. Serum was positive for GQ1b-IgM antibodies. Lumbar MRI showed gadolinium enhancement of the nerve roots and cauda equina. A standard regime of intravenous immunoglobulin markedly alleviated the low back pain. Conclusions Low back pain caused by GBS should be differentiated from other diseases. This initial or early prominent symptom may delay the diagnosis of GBS; therefore, it is important to conduct a detailed electrophysiological, CSF, and gadolinium-enhanced lumbar MRI analysis.

Masquerading Guillain-Barré syndrome: uncommon, in-hospital presentation of Miller-Fisher syndrome shadowed by secondary diseases

2021 ◽  
Vol 14 (2) ◽  
pp. e239133
Author(s):  
Viswanathan Pandurangan ◽  
Sujay Prabhath Dronamraju ◽  
Srinivasan Ramadurai ◽  
Preetam Arthur
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Extraocular Muscles ◽  
Guillain Barre Syndrome ◽  
Herniated Disc ◽  
Low Back ◽  
Fisher Syndrome ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
New Onset

Presentation of severe pain syndromes prior to onset of motor weakness is an uncommon but documented finding in patients with Guillain-Barré syndrome (GBS). Sciatica in GBS is a difficult diagnosis when patients present with acute radiculopathy caused by herniated disc or spondylolysis. A middle-aged woman was admitted for severe low back pain, symptomatic hyponatraemia, vomiting and constipation. On further investigation, she was diagnosed with radiculopathy, and appropriate treatment was initiated. Brief symptomatic improvement was followed by new-onset weakness in lower limbs, which progressed to involve upper limbs and right extraocular muscles. With progressive, ascending, new-onset motor and sensory deficits and laboratory evidence of demyelination by Nerve Conduction Study, a diagnosis of variant GBS was made. She was treated with intravenous immunoglobulin 2 g/kg over 5 days. The presentation of severe low back pain that was masking an existing aetiology and possible dysautonomia and the unilateral right extraocular muscles instead of bilateral make our case unique and rare.

Dermoid tumors of the spinal cord

1970 ◽  
Vol 33 (6) ◽  
pp. 676-681 ◽  
Author(s):  
Ian C. Bailey
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina ◽  
Complete Removal ◽  
Cord Compression ◽  
Conus Medullaris ◽  
Low Back ◽  
Content Type ◽  
Fine Print

✓ This is an analysis of 10 cases of dermoid tumor occurring in the spinal canal (8 lumbar and 2 thoracic). Low-back pain was the commonest presenting symptom, especially if the tumor was adherent to the conus medullaris. Other complaints included urinary dysfunction and motor and sensory disturbances of the legs. Clinical and radiological evidence of spina bifida was found in about half of the cases and suggested the diagnosis of a developmental type of tumor when patients presented with progressive spinal cord compression. At operation, the tumors were often found embedded in the conus medullaris or firmly adherent to the cauda equina, thus precluding complete removal. Evacuation of the cystic contents, however, gave lasting relief of the low-back pain and did not cause any deterioration in neurological function. In a follow-up study, ranging from 1 to 15 years, virtually no improvement in the neurological signs was observed. On the other hand, only one case has deteriorated due to recurrence of tumor growth.

Appropriateness of Imaging Decisions for Low Back Pain Presenting to the Emergency Department: A Retrospective Chart Review Study

2021 ◽  
Author(s):  
Adrian Traeger ◽  
Gustavo C Machado ◽  
Sally Bath ◽  
Martin Tran ◽  
Lucinda Roper ◽  
...  
Keyword(s):  
Emergency Department ◽  
Low Back Pain ◽  
Back Pain ◽  
Chart Review ◽  
Imaging Modality ◽  
Cauda Equina ◽  
Retrospective Chart Review ◽  
Low Back ◽  
Review Study ◽  
Hospital Emergency Departments

ABSTRACT Background Imaging for low back pain is widely regarded as a target for efforts to reduce low value care. We aimed to estimate the prevalence of overuse and underuse of lumbar imaging in the Emergency Department. Methods Retrospective chart review study of five public hospital Emergency Departments in Sydney, Australia, in 2019/20. We reviewed the clinical charts of consecutive adult patients who presented with a complaint of low back pain and extracted clinical features relevant to a decision to request lumbar imaging. We estimated the proportion of encounters where a decision to request lumbar imaging was inappropriate (overuse) or where a clinician did not request an appropriate and informative lumbar imaging test when indicated (underuse). Results 649 patients presented with a complaint of low back pain of which 158 (24.3%) were referred for imaging. 79 (12.2%) had a combination of features suggesting lumbar imaging was indicated according to clinical guidelines. The prevalence of overuse and underuse of lumbar imaging was 8.8% (57 of 649 cases, 95%CI 6.8% to 11.2%) and 4.3% (28 of 649 cases, 95%CI 3.0% to 6.1%), respectively. 13 cases were classified as underuse because the patient was referred for an uninformative imaging modality (e.g. referred for radiography for suspected cauda equina syndrome). Conclusion In this study of emergency care there was evidence of overuse of lumbar imaging, but also underuse through failure to request lumbar imaging when indicated or referral for an uninformative imaging modality. These three issues seem more important targets for quality improvement than solely focusing on overuse.

Low Back Pain in a Child Associated With Acute Onset Cauda Equina Syndrome

2012 ◽  
Vol 32 (3) ◽  
pp. 271-276 ◽  
Author(s):  
Juan Pretell-Mazzini ◽  
Kudakwashe R. Chikwava ◽  
John Paul Dormans
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Acute Onset ◽  
Low Back

scholarly journals The many faces of primary cauda equina myxopapillary ependymoma: clinicoradiological manifestations of two cases and review of the literature

2017 ◽  
Vol 31 (3) ◽  
pp. 385-390
Author(s):  
Mohammad Zare Mehrjardi ◽  
Samira Mirzaei ◽  
Hamid Reza Haghighatkhah
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Imaging Modality ◽  
Cauda Equina ◽  
Young Patients ◽  
Clinical Manifestations ◽  
Conus Medullaris ◽  
Lower Limbs ◽  
Myxopapillary Ependymoma ◽  
Low Back

Abstract Introduction: Myxopapillary ependymoma (MPE) is a benign and slow growing tumor that originates exclusively from the conus medullaris and cauda equina nervous tissue. It occurs more commonly in young patients. In addition, clinical presentations are non-specific and may mimic benign conditions. Magnetic resonance imaging (MRI) is the imaging modality of choice for evaluating this tumor. We hereby report on two young patients with long-lasting non-specific symptoms, which were clinically attributed to benign conditions. However, cauda equina tumor was revealed on MRI in both patients. Case report: Two cases of cauda equina MPE, a 19-year-old female and a 38-year-old male, with different clinical manifestations are reported. The first patient presented with paresis and paresthesia of the lower limbs, and the second patient’s complaint was chronic low-back pain and urinary incontinence. In both cases, MRI detected a tumor originated from the cauda equina, and histopathologic examination was compatible with MPE. Conclusion: Cauda equina tumors should be considered as a differential diagnosis in the young patients presented with neurologic deficits in the lower limbs, sphincter or erectile dysfunction, and even a simple low-back pain (particularly when symptoms are long-lasting and/or progressive).

scholarly journals Fluoroscopically-Guided Injections to Treat “Kissing Spine” Disease

2008 ◽  
Vol 4;11 (8;4) ◽  
pp. 549-554 ◽  
Author(s):  
Tim Lamer
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Spine ◽  
Soft Tissues ◽  
Nerve Fibers ◽  
Low Back ◽  
Mri Findings ◽  
Mri Features ◽  
Spinous Processes ◽  
Spine Disease

Background: Any spine structure that is innervated by afferent nociceptive nerve fibers is a potential pain generator. In the lumbar spine, the most studied pain generators include: sacroiliac joints, the zygapophysial joints, the intervertebral discs, myofascial structures. Anomalous lumbosacral articulations, the spinous processes, and lumbar spine osteophytes are less commonly reported. Objective: To describe the diagnostic and therapeutic features of “kissing spine” disease or Baastrup’s Sign with particular attention to MRI findings and fluoroscopicallyguided injection therapy. Design: A series of 3 patients with axial low back pain presented with exam findings and MRI changes suggestive of pain emanating from adjacent spinous processes that appeared to be in direct contact or very closely opposed. This has been described in the literature as “kissing spine” disease or Baastrup’s sign. Fluoroscopically-guided injections were performed and the responses were studied. Results: The 3 patients had MRI findings consisting of inflammation and/or edema in the spinous processes and surrounding soft tissues. Fluoroscopically-guided injections provided pain relief in all 3 patients. One patient with recurrent pain eventually underwent successful surgical resection of the involved spinous processes. Conclusion: Painful adjacent and closely opposed spinous processes can be a source of axial low back pain. We have described MRI features and the responses to fluoroscopically-guided injections in 3 patients with this condition. Key words: Baastrup’s, kissing spine, spine injection

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