scholarly journals Dorsal migration of lumbar disc fragments causing cauda equina syndromes: A three case series and literature review

2020 ◽  
Vol 11 ◽  
pp. 175
Author(s):  
Shawn Singh Rai ◽  
Carlos Rodrigo Goulart ◽  
Sepehr Lalezari ◽  
Michael Anthony Galgano ◽  
Satish Krishnamurthy
Keyword(s):  
Spinal Cord ◽  
Literature Review ◽  
Current Literature ◽  
Lumbar Disc ◽  
Correct Diagnosis ◽  
Cauda Equina ◽  
Case Series ◽  
Surgical Decompression ◽  
Case Description ◽  
Cauda Equina Compression

Background: Dorsal migration of an intervertebral lumbar disc fragment is exceedingly rare and may result in spinal cord or cauda equina compression. Radiologically, these lesions may be misdiagnosed as extradural masses or epidural hematomas. Case Description: We present three cases involving dorsal migration of sequestered lumbar disc fragments resulting in cauda equina syndromes. A 31-year-old male, 79-year-old female, and 47-year-old female presented with cauda equina syndromes attributed to the migration of dorsal sequestered lumbar disc fragments. Prompt surgical decompression resulted in adequate outcomes. Here, we review the three cases and the current literature for such lesions. Conclusion: Dorsal migration of sequestered lumbar disc fragments is exceedingly rare, and these lesions are frequently misdiagnosed as extradural masses of other origin or epidural hematomas. Here and in the literature, prompt epidural decompression both confirmed the correct diagnosis and resulted in excellent outcomes.

scholarly journals Intradural lumbar disc herniations at the L1–L2 level: A case study and literature review

2020 ◽  
Vol 11 ◽  
pp. 67
Author(s):  
Giancarlo Ponzo ◽  
Massimo Furnari ◽  
Giuseppe Emmanuele Umana ◽  
Massimiliano Giuffrida ◽  
Giovanni Federico Nicoletti ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Literature Review ◽  
Current Literature ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Acute Onset ◽  
Case Description ◽  
Lumbar Mri ◽  
Disc Herniations

Background: Intradural disc herniations (IDHs) are rare occurrences (0.26–0.30%), and most frequently involve the lumbar spine at the L4–L5 level. Here, we present a patient with an L1–L2 IDH and reviewed the current literature. Case Description: A 65-year-old female presented with the acute onset of bilateral paraparesis accompanied by urinary dysfunction. The lumbar MRI showed a mass at the L1–L2 level with caudal migration, accompanied by a positive “hawk-beak” sign. At surgery, consisting of a L1–L2 laminectomy, a large IDH was encountered responsible for marked cauda equina/root compression. Postoperatively, the patient immediately fully recovered. The literature we identified cited just seven similar studies of L1–L2 IDH. Conclusion: In a 65-year-old female, an IDH was anticipated at the L1–L2 level due to the combined MR findings of a large L1–L2 mass with caudal migration and the positive “hawk-beak” sign.

scholarly journals Recurrent thoracic cord compression due to extramedullary haematopoiesis in thalassaemic patients–A case presentation and literature review

2019 ◽  
Vol 26 (1) ◽  
pp. 43-47
Author(s):  
Athena Cheuk Yiu Au ◽  
Chun Kong Wong ◽  
Ka Kin Li
Keyword(s):  
Spinal Cord ◽  
Literature Review ◽  
Spinal Cord Compression ◽  
Case Reports ◽  
Case Series ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Thoracic Spinal Cord ◽  
Thoracic Spinal ◽  
Anaemia Management

Extramedullary haematopoesis (EMH) in thalassaemic patients to result in spinal cord compression is a rare phenomenon. EMH occurs as compensatory sequelae in those with chronic anaemia such as thalassaemia, other congenital haemolytic anaemia, haemoglobinopathies, and myelofibrosis. Common sites of EMH include liver, spleen, kidneys and lymph nodes, but rarely the paravertebral and spinal cord regions. In our literature review, it was found that only case reports and case series have been published. We present a case of recurrent thoracic spinal cord compression caused by EMH in a 32-year-old thalassaemic Chinese man treated with surgical decompression and spinal stabilisation. The key to successful treatment is prompt diagnosis with early clinical suspicion, magnetic resonance imaging and individualised treatment for each patient. Surgical decompression provides immediate neural decompression while subsequent anaemia management may reduce the risk of recurrence. In the present case, a combination therapy of blood transfusion, surgical decompression and radiotherapy has been shown to deliver successful outcomes in such cases.

scholarly journals Metastatic epidural spinal column compression due to pancreatic ductal adenocarcinoma causing subacute Cauda equina syndrome: A case report

2020 ◽  
Vol 11 ◽  
pp. 279
Author(s):  
Luis Diaz-Aguilar ◽  
Usman Khan ◽  
Ronald Sahyouni ◽  
Nolan James Brown ◽  
Scott Olson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Lumbar Spine ◽  
Pancreatic Ductal Adenocarcinoma ◽  
Cauda Equina ◽  
Spinal Column ◽  
Cord Compression ◽  
Surgical Decompression ◽  
Ductal Adenocarcinoma ◽  
Case Description

Background: Pancreatic ductal adenocarcinoma (PDAC) is the most common pancreatic malignancy, which rarely metastasizes to the spine. Case Description: Here, we present a lytic lumbar metastatic PDAC resulting in severe epidural spinal cord compression (ESCC) with instability. The lesion required preoperative particle embolization, surgical decompression, and fusion. Conclusion: This case report shows that PDAC may metastasize to the lumbar spine requiring routine decompression with fusion.

scholarly journals Alteration of the lysophosphatidic acid and its precursor lysophosphatidylcholine levels in spinal cord stenosis: A study using a rat cauda equina compression model

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Baasanjav Uranbileg ◽  
Nobuko Ito ◽  
Makoto Kurano ◽  
Daisuke Saigusa ◽  
Ritsumi Saito ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Lysophosphatidic Acid ◽  
Mass Spectrometry Imaging ◽  
Cauda Equina ◽  
Motor Dysfunction ◽  
Lipid Mediator ◽  
Neurogenic Claudication ◽  
Imaging Analysis ◽  
Cauda Equina Compression ◽  
Tissue Damages

Abstract Cauda equina compression (CEC) is a major cause of neurogenic claudication and progresses to neuropathic pain (NP). A lipid mediator, lysophosphatidic acid (LPA), is known to induce NP via the LPA1 receptor. To know a possible mechanism of LPA production in neurogenic claudication, we determined the levels of LPA, lysophosphatidylcholine (LPC) and LPA-producing enzyme autotaxin (ATX), in the cerebrospinal fluid (CSF) and spinal cord (SC) using a CEC as a possible model of neurogenic claudication. Using silicon blocks within the lumbar epidural space, we developed a CEC model in rats with motor dysfunction. LPC and LPA levels in the CSF were significantly increased from day 1. Importantly, specific LPA species (16:0, 18:2, 20:4) were upregulated, which have been shown to produce by ATX detected in the CSF, without changes on its level. In SC, the LPC and LPA levels did not change, but mass spectrometry imaging analysis revealed that LPC was present in a region where the silicon blocks were inserted. These results propose a model for LPA production in SC and CSF upon neurogenic claudication that LPC produced locally by tissue damages is converted to LPA by ATX, which then leak out into the CSF.

The Neurological Compromised Spine Due to Ewing Sarcoma. What First

Neurosurgery ◽  
2015 ◽  
Vol 77 (5) ◽  
pp. 718-725 ◽  
Author(s):  
Lida Mirzaei ◽  
Suzanne E.J. Kaal ◽  
Hendrik W.B. Schreuder ◽  
Ronald H.M.A. Bartels
Keyword(s):  
Ewing Sarcoma ◽  
Neurological Deficit ◽  
Multidisciplinary Approach ◽  
Cauda Equina ◽  
Case Series ◽  
Decompressive Laminectomy ◽  
Cauda Equina Compression ◽  
Before And After ◽  
Frankel Grade

Abstract BACKGROUND: The vertebral column is an infrequent site of primary involvement in Ewing sarcoma. Yet when Ewing sarcoma is found in the spine, the urge for decompression is high because of the often symptomatic compression of neural structures. It is unclear in alleviating a neurological deficit whether chemotherapy is preferred over decompressive laminectomy. OBJECTIVE: To underline, in this case series, the efficiency of initial chemotherapy before upfront surgery in the setting of high-grade spinal cord or cauda equina compression of primary Ewing sarcoma. METHODS: Fifteen patients with Ewing sarcoma primarily located in the spine were treated at our institution between 1983 and 2015. Localization, neurological deficit expressed as Frankel grade, and outcome expressed as Rankin scale before and after initial chemotherapy, the recurrence rate, and overall survival were evaluated. The multidisciplinary approach of 1 case will be discussed in detail. RESULTS: Nine patients (60%) were female. The age at presentation was 15.0 ± 5.5 years (range: 0.9–22.8 years). Ten patients (67%) were initially treated with chemotherapy, and 1 patient (7%) was treated primarily with radiotherapy followed by chemotherapy. The remaining 4 patients (27%) were initially treated with decompressive surgery. All patients treated primarily nonsurgically improved neurologically at follow-up, showing the importance of chemotherapy as an effective initial treatment option. CONCLUSION: Adequate and quick decompression of neural structures with similar results can be achieved by chemotherapy and radiotherapy, avoiding the local spill of malignant cells.

Spinal arterial malformation in a child with hereditary hemorrhagic telangiectasia

1976 ◽  
Vol 44 (5) ◽  
pp. 613-616 ◽  
Author(s):  
Glen S. Merry ◽  
D. Barry Appleton
Keyword(s):  
Spinal Cord ◽  
Family History ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Cauda Equina ◽  
Content Type ◽  
Cauda Equina Compression ◽  
History Of ◽  
Spinal Aneurysm ◽  
Arterial Malformation ◽  
Fine Print

✓ A case is reported of spinal aneurysm in a child with a family history of hereditary hemorrhagic telangiectasia causing spinal cord and cauda equina compression. The operative approach is discussed.

scholarly journals Symptomatic mature teratoma of the lumbar spine: A case report

2022 ◽  
Vol 13 ◽  
pp. 16
Author(s):  
Coby Cunningham ◽  
Chiara Flores ◽  
Rocco Dabecco ◽  
Palgun Nisarga ◽  
Janice Ahn ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Surgical Intervention ◽  
Mature Teratoma ◽  
Cauda Equina ◽  
Case Description ◽  
Acute Setting ◽  
The Central Nervous System ◽  
Well Differentiated ◽  
Ct Brain ◽  
Mr Brain

Background: Teratomas are a unique family of tumors derived from two or more of the three embryonic layers: endoderm, mesoderm, and ectoderm. Mature teratomas are comprised the most well-differentiated tissue types and may contain skin, hair, teeth, smooth muscle, respiratory tissues, etc. Infrequently, mature teratomas may be found within the central nervous system and, in exceedingly rare cases, may be occur within the spinal cord itself (i.e., intramedullary/intradural). Case Description: A 78-year-old female presented with a subacute progressive lower extremity paraparesis. The MR revealed a cystic 81 × 30 × 25 mm intradural/intramedullary spinal mass involving the distal conus with exophytic extension into the L1-L4 spinal canal. Following surgical intervention consisting of a L1-L4 laminectomy, the lesion was largely removed. Pathology of the mass confirmed a large mature teratoma containing a multilobulated cyst that intraoperatively compressed the conus and cauda equina. Immediately postoperatively, the patient significantly improved neurologically. However, on postoperative day 2, she acutely developed a change in mental status with the left gaze preference and hemiparesis. CT brain in the acute setting showed no evidence of causative pathology and subsequent MR brain was unremarkable. The patient’s neurologic deficits progressively improved leading to eventual discharge. Conclusion: Intrathecal intramedullary/extramedullary mature teratomas of the conus that results in subacute cauda equina syndromes are rare. The differential diagnosis for such lesions exophytic to the conus must include mature teratomas which, though rare, may be readily resected resulting in generally favorable outcomes.

scholarly journals Clinical heterogeneity of low flow spinal arteriovenous fistulas; a case series

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
D. Krishnan ◽  
S. Viswanathan ◽  
N. Rose ◽  
H. S. N. Benjamin ◽  
A. M. Ong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Immune Therapy ◽  
False Negative ◽  
Spastic Paraparesis ◽  
Cauda Equina ◽  
Case Series ◽  
Low Flow ◽  
Cervical Region ◽  
Lumbar Region ◽  
Post Surgery

Abstract Background Spinal AVF (SAVF), a potentially treatable cause of myelopathy, remains a challenging diagnosis. Its rarity and non-specific imaging findings often result in misdiagnosis despite a high index of clinical suspicion. The classically described high T2 signal in the spinal cord or prominent vascular flow voids in the intradural space were not infrequently missed on initial imaging, only to be picked up at follow-up imaging after progression of symptoms. Additionally, small sized fistulas(< 1 mm) and SAVF involving less frequent locations like the craniocervical junction in a patient presenting with paraplegia further complicates the diagnosis. On rare occasions, acute atypical presentation following a surgery adds to the conundrum. Definite diagnosis with spinal angiography, the gold-standard modality requires the expertise of highly skilled interventionists which may otherwise lead to false negative findings. We describe four SAVF patients with unconventional presentations, highlighting less described clinical findings. Case presentation First was a 50-year-old man presented with spastic paraparesis and was found to have an AVF at the cervical region arising from the vertebral artery. Second, a 45-year-old man with acute paraplegia post-operatively, initially treated for a transverse myelitis before lumbar region AVF was detected. Thirdly, a 27-year-old man presented with subacute lower thoracic myelopathy and deteriorated after corticosteroid treatment. The last patient, who initially appeared to have conus medullaris/cauda equina syndrome had a SAVF at the mid thoracic level. Presentation varied with some exhibiting acute deterioration mimicking other spinal cord pathology such as inflammatory disorders. All patients eventually underwent endovascular treatment with successful embolization of SDAVF. None of them exhibited further neurological deterioration after embolization. Conclusion Successful treatment of SAVF is possible provided the diagnosis is made early, allowing timely intervention. Certain clues may aid the diagnosis. Firstly, arteriovenous fistula can be located distant to the clinical localization of myelopathy resulting in the unexpected longitudinally extensive spinal cord signal change. This clinical-radiological discrepancy can be a useful clue in diagnosing SAVF. Secondly, an acute myelopathic presentation immediately post-surgery may be related to SAVF. Other SAVF feature of note includes progressive myelopathy mimicking immune-mediated myelitis among young adults below 30 years of age refractory to immune therapy.

Sign in / Sign up

Export Citation Format

Share Document