scholarly journals Resolution of cauda equina syndrome after surgical extraction of lumbar intrathecal bullet

2020 ◽  
Vol 11 ◽  
pp. 214
Author(s):  
Zaid Aljuboori ◽  
Emily Sieg
Keyword(s):  
Lower Extremity ◽  
Urinary Retention ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Spinal Column ◽  
Neurological Damage ◽  
Burning Pain ◽  
Extensor Hallucis Longus ◽  
Surgical Extraction ◽  
The Right

Background: Gunshot wound (GSW) injuries to the spinal column are correlated with potentially severe neurological damage. Here, we describe a GSW to the thoracolumbar junction (e.g., T12/L1 level) which resulted in a cauda equina syndrome that resolved once the bullet was removed. Case Description: A 29-year-old male presented with a T12-L1 GSW; the bullet traversed the right chest and liver, entered the spinal canal at T12, and then settled at L1. He experienced excruciating burning pain in the right lower extremity/perineum and had urinary retention. On neurological examination, he exhibited severe weakness of the right iliopsoas/quadriceps (2/5) and extensor hallucis longus (1/5) which had decreased sensation in the right lower extremity in all dermatomes and urinary retention. The myelogram showed the bullet lodged intrathecally at L1; it compressed the cauda equina. Immediately after, the bullet was extracted and at 8 weeks follow-up, the patient’s right-sided motor function normalized, the sensory findings improved, and the sphincteric dysfunction resolved; the only residual deficit was minimal residual numbness in the L2-L5 distributions. Conclusion: Twenty percent of penetrating spinal column injuries are attributed to GSW s. The location of these injuries best determines the neurological damage and degree of recovery. Since patients with incomplete cauda equina syndromes have favorable prognoses, removal of bullets involving the T12-S1 levels may prove beneficial.

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.

Acute cauda equina syndrome from a ruptured aneurysm in the sacral canal

1992 ◽  
Vol 77 (6) ◽  
pp. 945-948 ◽  
Author(s):  
Richard H. Schmidt ◽  
M. Sean Grady ◽  
Wendy Cohen ◽  
Sanford Wright ◽  
H. Richard Winn
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Signs And Symptoms ◽  
Vascular Supply ◽  
Ruptured Aneurysm ◽  
Collateral Flow ◽  
Content Type ◽  
Internal Iliac ◽  
The Right ◽  
Sacral Canal

✓ The case is presented of a young woman with acute cauda equina syndrome from a ruptured aneurysm in the sacral canal. The lesion was associated with pathological enlargement of the lateral sacral arteries bilaterally, which presumably occurred to provide cross-pelvic collateral flow in response to the diversion of the right internal iliac artery for renal transplantation. The patient presented with signs and symptoms of spontaneous spinal epidural hemorrhage. The radiographic features of this lesion are described. In addition to angiography and partial embolization of the vascular supply, contrast-enhanced high-resolution computerized tomography was essential in the diagnosis and treatment of this unique aneurysm.

scholarly journals Dorsal extrusion of intervertebral disc as a cause of cauda equina syndrome

2011 ◽  
Vol 64 (7-8) ◽  
pp. 419-421
Author(s):  
Aldin Jusic ◽  
Rasim Skomorac ◽  
Hakija Beculic
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Intervertebral Disc ◽  
Urinary Retention ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Good Recovery ◽  
Resonance Imaging ◽  
Extradural Space

We have presented a case of rare dorsally sequestrated lumbar disc herniation manifesting as cauda equina syndrome. The patient was admitted to the Neurological Department of Canton Hospital Zenica due to urinary retention and weakness in both lower extremities. Magnetic resonance imaging showed a compressing mass located in the dorsal extradural space at the L2- L3 level. An extruded intervertebral disc was found intraoperatively. The decompression was followed by good recovery.

scholarly journals Unilateral Cauda Equina Syndrome Due to Cancer Metastasis Diagnosed with Electromyography: A Case Report

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1370
Author(s):  
Chan-Hee Park ◽  
Eunhee Park ◽  
Tae-Du Jung
Keyword(s):  
Lumbar Spine ◽  
Cauda Equina Syndrome ◽  
Cancer Metastasis ◽  
Proper Time ◽  
Cauda Equina ◽  
B Cell Lymphoma ◽  
Leg Pain ◽  
Muscle Membrane ◽  
The Right ◽  
Hands And Feet

Background: Typical cauda equina syndrome (CES) presents as low back pain, bilateral leg pain with motor and sensory deficits, genitourinary dysfunction, saddle anesthesia and fecal incontinence. In addition, it is a neurosurgical emergency, which is essential to diagnose as soon as possible, and needs prompt intervention. However, unilateral CES is rare. Here, we report a unique case of a patient who had unilateral symptoms of CES due to cancer metastasis and was diagnosed through electromyography. Methods: A 71-year-old man with diffuse large B cell lymphoma (DLBCL) suffered from severe pain, motor weakness in the right lower limb and urinary incontinence, and hemi-saddle anesthesia. It was easy to be confused with lumbar radiculopathy due to the unilateral symptoms. Lumbar spine magnetic resonance imaging (MRI) showed suspected multifocal bone metastasis in the TL spine, including T11-L5, the bilateral sacrum and iliac bones, and suspected epidural metastasis at L4/5, L5/S1 and the sacrum. PET CT conducted after the third R-CHOP showed residual hypermetabolic lesions in L5, the sacrum, and the right presacral area. Results: Nerve conduction studies (NCS) revealed peripheral neuropathy in both hands and feet. Electromyography (EMG) presented abnormal results indicating development of muscle membrane instability following neural injury, not only on the right symptomatic side, but also on the other side which was considered intact. Overall, he was diagnosed with cauda equina syndrome caused by DLBCL metastasis, and referred to neurosurgical department. Conclusions: Early diagnosis of unilateral CES may go unnoticed due to its unilateral symptoms. Failure to perform the intervention at the proper time can impede recovery and leave permanent complications. Therefore, physicians need to know not only the typical CES, but also the clinical features of atypical CES when encountering a patient, and further evaluation such as electrodiagnostic study or lumbar spine MRI have to be considered.

scholarly journals P31 Cauda equina syndrome – the importance of an early, accurate diagnosis and treatment in preventing bladder dysfunction

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Victoria Amy Porter ◽  
Victoria Porter
Keyword(s):  
Urinary Retention ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Accurate Diagnosis ◽  
Diagnostic Methods ◽  
Diagnosis And Treatment ◽  
Decompressive Surgery ◽  
Bladder Function ◽  
Urological Complications ◽  
Significant Difference

Abstract Introduction Cauda Equina Syndrome (CES), is a neurological emergency with many urological features. Delayed decompressive surgery can cause urinary retention, overflow incontinence, long term catherization and loss of sexual function. This article focusses on the accuracy of the initial diagnosis and the time taken before treatment is commenced. Methods In this systematic literature review, OneSearch and PubMed have been searched for articles which identify the main symptoms of CES, evaluate the effectiveness of several diagnostic methods and compare the postoperative results of bladder function following timely and delayed treatment. Results A total of 20 articles have been referenced, of which 9 studies have been reviewed. While no individual symptom is 100% indicative of CES, urinary retention (diagnostic accuracy 0.9), is the most consistent clinical finding. Therefore, MRI is necessary for an accurate diagnosis. Further 4 out of 5 studies state that treatment within 24-hours improves patient outcomes compared to 48-hours, one study showed no significant difference between 24 and 48 hours. All articles indicate beyond 48-hours, surgical intervention has little impact on the relief of symptoms. Conclusion The studies concluded that any patient presenting in the emergency department with lower back pain should be screened for CES. A thorough history and neurological examination should be performed; however, the evidence base for rectal examination to assess anal tone is poor. Decompressive surgery carried out within the first 24-hour period from the onset of symptoms is favourable. Overall, early accurate diagnosis and treatment is invaluable to preventing urological complications and improving prognosis.

Cauda Equina Syndrome

2000 ◽  
Vol 5 (1) ◽  
pp. 1-2
Author(s):  
Leon H. Ensalada
Keyword(s):  
Lower Extremity ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Leg Pain ◽  
Lower Extremity Function ◽  
Lower Extremity Weakness ◽  
Injury Model ◽  
History Of ◽  
Radicular Syndrome ◽  
Lumbar Spinal

Abstract The cauda equina is a collection of peripheral nerves in the common dural sheath within the lumbar spinal canal. Cauda equina syndrome, also known as bilateral acute radicular syndrome, usually is caused by a large, sequestered acute disc rupture at L3-4, L4-5, or L5-S1 that produces partial or complete lesions of the cauda equina–lower motor neuron lesions associated with flaccid paralysis, atrophy, and other conditions. Patients usually present with a history of back symptoms that have worsened precipitously. The syndrome includes back pain, bilateral leg pain, saddle anesthesia, bilateral lower extremity weakness, urinary bladder retention, and lax rectal tone. Cauda equina syndrome is rated using Diagnosis-related estimates (DRE) lumbosacral categories VI or VII. Category VI, Cauda Equina–like Syndrome Without Bowel or Bladder Signs, is used when there is permanent bilateral partial loss of lower extremity function but no bowel or bladder impairment. Category VII, Cauda Equina Syndrome with Bowel or Bladder Impairment, is similar to Category VI but also includes bowel or bladder impairment. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) uses the term cauda equina syndrome with reference to both the thoracolumbar and cervicothoracic spine regions; this usage is unique to the AMA Guides but maintains the internal consistency of the Injury Model, which is the best approach to date for assessing spine impairment.

Nondural-based lumbar clear cell meningioma

1996 ◽  
Vol 84 (2) ◽  
pp. 264-266 ◽  
Author(s):  
Robert N. N. Holtzman ◽  
Susan C. Jormark
Keyword(s):  
Clear Cell ◽  
Cauda Equina ◽  
Complete Removal ◽  
Leg Pain ◽  
Content Type ◽  
Single Root ◽  
Clear Cell Meningioma ◽  
Extensor Hallucis Longus ◽  
The Right ◽  
Immunohistochemical Analyses

✓ This 32-year-old man had noticed right leg pain for 4 years and developed classic right sciatica after heavy lifting, followed by episodes of buckling of both legs 1 month prior to admission. His medical history included congenital left abducens palsy. Examination revealed a right Lasègue's sign and Fajersztajn's sign with mild weakness of the right extensor hallucis longus. Magnetic resonance imaging revealed a 1.5 × 2.0—cm enhancing intradural lesion at the L3–4 level. Following laminectomy of L-3 and L-4 and intradural exposure, the tumor was found to be draped loosely by the roots of the cauda equina and attached to a single root without any adherence to dura. Transection of the adherent fascicles and typical microdissection of arachnoidal filaments permitted its complete removal without violation of the capsule, allowing the preservation of a large fascicle. The patient's recovery was uneventful. Postoperatively, a mild right lateral foot hypalgesia and diminution of the right ankle jerk implicated the S-1 root. Histological and immunohistochemical analyses diagnosed the specimen as a clear cell meningioma.

Thoracic diastematomyelia with concurrent intradural epidermoid spinal cord tumor and cervical syrinx in an adult

2002 ◽  
Vol 97 (2) ◽  
pp. 231-234 ◽  
Author(s):  
Jason P. Sheehan ◽  
Jonas M. Sheehan ◽  
M. Beatriz Lopes ◽  
John A. Jane
Keyword(s):  
Spinal Cord ◽  
Lower Extremity ◽  
Epidermoid Cyst ◽  
Spinal Cord Tumor ◽  
Cauda Equina ◽  
Content Type ◽  
Lower Extremity Pain ◽  
Microscopic Evaluation ◽  
The Right ◽  
Fine Print

✓ Diastematomyelia is a rare entity in which some portion of the spinal cord is split into two by a midline septum. Most cases occur in childhood, but some develop in adulthood. A variety of concurrent spinal anomalies may be found in patients with diastematomyelia. The authors describe a 38-year-old right-handed woman who presented with a 7-month history of lower-extremity pain and weakness on the right side. She denied recent trauma or illness. Sensorimotor deficits, hyperreflexia, and a positive Babinski reflex in the right lower extremity were demonstrated on examination. Neuroimaging revealed diastematomyelia extending from T-1 to T-3, an expanded right hemicord from T-2 to T-4, and a C6–7 syrinx. The patient underwent T1–3 total laminectomies, resection of the septum, untethering of the cord, and excision of the hemicord lesion. The hemicord mass was determined to be an intramedullary epidermoid cyst; on microscopic evaluation the diastematomyelia cleft was shown to contain fibroadipose connective tissue with nerve twigs and ganglion cells. Postoperatively, the right lower-extremity pain, weakness, and sensory deficits improved. Diastematomyelia can present after a long, relatively asymptomatic period and should be kept in the differential diagnosis for radiculopathy, myelopathy, tethered cord syndrome, or cauda equina syndrome. Numerous spinal lesions can be found in conjunction with diastematomyelia. To the authors' knowledge, this is the first case in which a thoracic epidermoid cyst and cervical syrinx occurred concurrently with an upper thoracic diastematomyelia. Thorough neuraxis radiographic evaluation and surgical treatment are usually indicated.

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