scholarly journals Spinal cord ischemia/infarct after cauda equina syndrome from disc herniation – A case study and literature review

2019 ◽  
Vol 10 ◽  
pp. 80
Author(s):  
David C. Kramer ◽  
Adela Aguirre-Alarcon ◽  
Reza Yassari ◽  
Allan L. Brook ◽  
Merritt D. Kinon
Keyword(s):  
Spinal Cord ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Spinal Cord Ischemia ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Foot Drop ◽  
Neurological Deficits ◽  
Vascular Lesions ◽  
Spinal Cord Infarction

Background: Spinal cord infarction is rare and occurs in 12/100,000; it represents 0.3%–2% of central nervous system infarcts. Here, we present a patient who developed recurrent bilateral lower extremity paraplegia secondary to spinal cord infarction 1 day after a successful L4-5 microdiscectomy in a patient who originally presented with a cauda equina syndrome. Case Description: A 56-year-old patient presented with an acute cauda equina syndrome characterized by severe lower back pain, a right foot drop, saddle anesthesia, and acute urinary retention. When the lumbar magnetic resonance imaging (MRI) revealed a large right paracentral lumbar disc herniation at the L4-L5 level, the patient underwent an emergency minimally invasive right-sided L4-5 discectomy. Immediately, postoperatively, the patient regained normal function. However, 1 day later, while having a bowel movement, he immediately developed the recurrent paraplegia. The new lumbar MRI revealed acute ischemia and an infarct involving the distal conus medullaris. Further, workup was negative for a spinal cord vascular malformation, thus leaving an inflammatory postsurgical vasculitis as the primary etiology of delayed the conus medullaris infarction. Conclusions: Acute neurologic deterioration after spinal surgery which does not neurologically correlate with the operative level or procedure performed should prompt the performance of follow-up MR studies of the neuraxis to rule out other etiologies, including vascular lesions versus infarctions, as causes of new neurological deficits.

scholarly journals Tethered Cord Syndrome

2019 ◽  
Vol 3 (3) ◽  
pp. 297-298
Author(s):  
Shawn Catmull ◽  
John Ashurst
Keyword(s):  
Spinal Cord ◽  
Emergency Department ◽  
Emergency Physician ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Tethered Cord ◽  
Signs And Symptoms ◽  
Conus Medullaris ◽  
Tethered Spinal Cord ◽  
Sensory Dysfunction

Tethered spinal cord syndrome refers to signs and symptoms of motor and sensory dysfunction related to increased tension on the spinal cord due to its abnormal attachment; it has classically been associated with a low-lying conus medullaris. Treatment is primarily surgical and has varying degrees of results. Although rarely diagnosed in the emergency department, the emergency physician must be aware of the disease in patients presenting with signs and symptoms concerning for cauda equina syndrome.

scholarly journals Surgical removal of a spinal intrathecal projectile led to a significant improvement of cauda equina syndrome

2020 ◽  
Vol 11 ◽  
pp. 227
Author(s):  
Zaid Aljuboori
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Gunshot Wounds ◽  
Foot Drop ◽  
Neurological Deficits ◽  
Neurological Injury ◽  
Surgical Removal ◽  
Neurological Outcomes ◽  
Burning Pain ◽  
The Right

Background: Penetrating gunshot wounds of the spine are common and can cause severe neurological deficits. However, there are no guidelines as to their optimal treatment. Here, we present a penetrating injury to the lower thoracic spine at the T12 level that lodged within the canal at L1, resulting in a cauda equina syndrome. Notably, the patient’s deficit resolved following bullet removal. Case Description: A 29-year-old male sustained a gunshot injury. The bullet entered the right lower chest, went through the liver, entered the spinal canal at T12, fractured the right T12/L1 facet, and settled within the canal at the L1 level. The patient presented with severe burning pain in the right leg, and perineum. On exam, he had right-sided moderate weakness of the iliopsoas and quadriceps femoris muscles, a right-sided foot drop, decreased sensation throughout the right leg, and urinary retention. Computed tomography myelography showed the bullet located intrathecally at the L1 level causing compression of the cauda equina. The patient underwent an L1 laminectomy with durotomy for bullet removal. Immediately postoperatively, the patient improved; motor power returned to normal, the sensory exam significantly improved; and he was left with only mild residual numbness and burning pain in the right leg. Conclusion: With gunshot injuries, there is a direct correlation between the location/severity of the neurological injury and the potential for recovery. In patients with incomplete cauda equina syndromes, bullet extraction may prove beneficial to neurological outcomes.

scholarly journals Sudden paraparesis due to spinal cord ischemia with initial contrast enhancement of the cauda equina and time-delayed owl-eyes sign on follow-up MR imaging: a case report

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Benedict Breitling ◽  
Frederic Carsten Schmeel ◽  
Alexander Radbruch ◽  
Oliver Kaut
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Contrast Enhancement ◽  
Spinal Cord Ischemia ◽  
Cauda Equina ◽  
Conus Medullaris ◽  
Spinal Ischemia ◽  
Nerve Roots ◽  
Anterior Portion

AbstractWe report on a case of a 52-year-old male with sudden paraparesis. The initial MRI showed contrast enhancement of the conus medullaris and the complete cauda equina. Follow-up MRI revealed a spinal ischemia in the anterior portion of the spinal cord. Only a few reports with similar findings have been published. We suggest that contrast enhancement of the conus medullaris and descending nerve roots can be a potential first indicator of a spinal cord ischemia.

scholarly journals Acute bilateral foot drop with or without cauda equina syndrome—a case series

2021 ◽  
Vol 163 (4) ◽  
pp. 1191-1198
Author(s):  
Andreas K. Demetriades ◽  
Marco Mancuso-Marcello ◽  
Asfand Baig Mirza ◽  
Joseph Frantzias ◽  
David A. Bell ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Case Series ◽  
Foot Drop ◽  
Spinal Disease ◽  
Full Resolution ◽  
Degenerative Spinal Disease ◽  
The Mean ◽  
The One

Abstract Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma and relevant systemic illness excluded. Methods Data from three different centres had been collected at the time of historic treatment, and records were subsequently reviewed retrospectively, documenting the clinical presentation, radiological level of compression, timing of surgery, and degree of neurological recovery. Results Seven patients are presented. The mean age at presentation was 52.1 years (range 41–66). All patients but one were male. All had a painful radiculopathic presentation. Relevant discopathy was observed from L2/3 to L5/S1, the commonest level being L3/4. Five were treated within 24 h of presentation, and two within 48 h. Three had concomitant cauda equina syndrome; of these, the first two made a full motor recovery, one by 6 weeks follow-up and the second on the same-day post-op evaluation. Overall, five out of seven cases had full resolution of their ankle dorsiflexion pareses. One patient with 1/5 power has not improved. Another with 1/5 weakness improved to normal on the one side and to 3/5 on the other. Conclusion When bilateral foot drop occurs acutely, we encourage the consideration of degenerative spinal disease. Relevant discopathy was observed from L2/3 to L5/S1; aberrant innervation may be at play. Cauda equina syndrome is not necessarily associated with acute bilateral foot drop. The prognosis seems to be pretty good with respect to recovery of the foot drop, especially if partial at presentation and if treated within 48 h.

Thoracic spinal cord compression masquerading as cauda equina syndrome

2016 ◽  
Vol 34 (4) ◽  
pp. 756.e3-756.e5 ◽  
Author(s):  
Katherine Stolper ◽  
Erin R. Hanlin ◽  
Michael D. April ◽  
John L. Ritter ◽  
Curtis J. Hunter ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Cord Compression ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal

scholarly journals Outcome of Delayed Decompression Surgery for Cauda Equina Syndrome secondary to Lumbar Disc Herniation: A Case Report

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Lim SM ◽  
Johari J ◽  
Yusof MI
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Bowel Dysfunction ◽  
Decompression Surgery ◽  
Motor Weakness ◽  
Post Surgery ◽  
Maximum Improvement

Cauda equina syndrome (CES) is a constellation of symptoms which consist of low back pain, sciatica, saddlearea paraesthesia, urinary or faecal incontinence, with or without motor weakness, and sensory deficit. Surgical decompression is indicated as soon as possible, as decompression within 48 hours from onset allows maximum improvement of symptoms. Recovery usually occurs months or years postoperatively. We report a case of a patient with cauda equina syndrome secondary to massive lumbar disc herniation who had undergone urgent decompression one week after onset of urinary and bowel dysfunction. The clinical outcome post surgery was also discussed.

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.

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