Cauda equina syndrome secondary to an absent inferior vena cava managed with surgical decompression

The authors report on the case of a 24-year-old man who presented with back pain and radiculopathy due to epidural venous engorgement in the setting of a congenitally absent inferior vena cava. Despite initial improvement after steroid administration, the patient's health ultimately declined over a period of weeks, and signs and symptoms of cauda equina syndrome manifested. Lumbar decompression was performed and involved coagulation and resection of the compressive epidural veins. No complications occurred, and the patient made a full neurological recovery.

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Epidural venous plexus engorgement due to inferior vena cava thrombosis resulting in cauda equina syndrome: Case report and literature review

Surgical Neurology International ◽

10.4103/sni.sni_115_18 ◽

2018 ◽

Vol 9 (1) ◽

pp. 129 ◽

Cited By ~ 1

Author(s):

TinaW Wong ◽

DanielG Gridley ◽

Iman Feiz-Erfan

Keyword(s):

Case Report ◽

Literature Review ◽

Inferior Vena Cava ◽

Cauda Equina Syndrome ◽

Inferior Vena ◽

Cauda Equina ◽

Vena Cava ◽

Venous Plexus ◽

Vena Cava Thrombosis ◽

Inferior Vena Cava Thrombosis

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Acute cauda equina syndrome caused by thrombosis of the inferior vena cava

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.67.6.827 ◽

1999 ◽

Vol 67 (6) ◽

pp. 827-828 ◽

Cited By ~ 7

Author(s):

J. DE KRUIJK ◽

A. KORTEN ◽

J. BOITEN ◽

J. WILMINK

Keyword(s):

Inferior Vena Cava ◽

Cauda Equina Syndrome ◽

Inferior Vena ◽

Cauda Equina ◽

Vena Cava

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Sacral preservation in cauda equina syndrome from inferior vena cava thrombosis

Journal of Neurosurgery Spine ◽

10.3171/2008.12.spine08389 ◽

2009 ◽

Vol 10 (3) ◽

pp. 257-259 ◽

Cited By ~ 3

Author(s):

Alik S. Widge ◽

Nestor D. Tomycz ◽

Adam S. Kanter

Keyword(s):

Inferior Vena Cava ◽

Cauda Equina Syndrome ◽

Inferior Vena ◽

Relevant Literature ◽

Cauda Equina ◽

Vena Cava ◽

Perioperative Period ◽

Ivc Thrombosis ◽

Ivc Filters ◽

Acute Paraparesis

Acute cauda equina syndrome can occur due to a variety of causes. Inferior vena cava (IVC) thrombosis has been reported as the causal source of this phenomenon twice in the relevant literature, both cases of which presented in a form complete with a component of bowel and/or bladder dysfunction. The authors report an atypical case of cauda equina syndrome in a patient in a hypercoagulable state with an extensive IVC thrombosis, resulting in acute paraparesis in the absence of incontinence or perineal anesthesia. An increasing number of prophylactic and/or therapeutic IVC filters placed in the perioperative period should engender an increased clinical suspicion for IVC thrombosis in patients presenting with acute paraparesis.

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Inferior vena cava thrombosis causing acute cauda equina syndrome

Journal of Neurosurgery Pediatrics ◽

10.3171/ped.2006.104.1.46 ◽

2006 ◽

Vol 104 (1) ◽

pp. 46-49 ◽

Cited By ~ 3

Author(s):

A. Alex Mohit ◽

David J. Fisher ◽

Dana C. Matthews ◽

Eric Hoffer ◽

Anthony M. Avellino

Keyword(s):

Inferior Vena Cava ◽

Cauda Equina Syndrome ◽

Inferior Vena ◽

Cauda Equina ◽

Vena Cava ◽

Vena Cava Thrombosis ◽

Inferior Vena Cava Thrombosis

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Myelopathy-mimicking symptoms of epidural venous engorgement and syringomyelia due to inferior vena cava stenosis at the thoracolumbar junction in a patient with Budd-Chiari syndrome

Journal of Neurosurgery Spine ◽

10.3171/2015.1.spine14515 ◽

2015 ◽

Vol 23 (4) ◽

pp. 467-470 ◽

Cited By ~ 4

Author(s):

Jung-Hee Lee ◽

Wook-Jae Song ◽

Kyung-Chung Kang

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Cauda Equina ◽

Vena Cava ◽

Neurogenic Claudication ◽

Type I ◽

Budd Chiari Syndrome ◽

Lower Extremity Weakness ◽

Sonographic Guidance ◽

Chiari Syndrome

Epidural venous engorgement can result from various lesions, such as arteriovenous malformation, thrombosis or occlusion of the inferior vena cava (IVC), or an abdominal masslike lesion. Most patients with these problems complain of low-back pain, radicular pain, or neurogenic claudication, which are symptoms suggestive of disc herniation or spinal stenosis. However, these patients rarely exhibit neurological deficits or cauda equina syndrome. The authors encountered a case of a 60-year-old man presenting with lower-extremity weakness and voiding difficulty for a period of 1 year. To investigate the patient’s myelopathy-mimicking symptoms, a lumbar spine MRI scan was performed. The MR images exhibited tortuous and dilated spinal vessels compressing the spinal cord and thecal sac at the T11-L3 level, which were concurrent with syringomyelia evidenced by a 22 × 2.5-mm cyst at the T11–12 level. 3D CT scanning of the whole aorta revealed total occlusion and regression of the IVC in the intrahepatic region 3 cm inferior to the right atrium and dilation of multiple collateral veins. The patient was diagnosed with chronic Budd-Chiari syndrome Type I. The authors performed venography, followed by intrahepatic IVC recanalization via stent placement under fluoroscopic and ultra sonographic guidance and without surgical exploration. After this treatment, there was a marked decrease in epidural venous engorgement and the patient’s symptoms resolved almost completely. This case indicates that epidural venous engorgement at thoracolumbar levels may cause symptoms suggestive of myelopathy and can be successfully treated by minimally invasive procedures to eliminate the underlying causes.

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Inferior vena cava thrombosis: A review of current practice

Vascular Medicine ◽

10.1177/1358863x12471967 ◽

2013 ◽

Vol 18 (1) ◽

pp. 32-43 ◽

Cited By ~ 56

Author(s):

BJ McAree ◽

ME O’Donnell ◽

GJ Fitzmaurice ◽

JA Reid ◽

RAJ Spence ◽

...

Keyword(s):

Inferior Vena Cava ◽

Lower Limb ◽

Inferior Vena ◽

Vena Cava ◽

Signs And Symptoms ◽

Primary Diagnosis ◽

Imaging Tool ◽

Ivc Thrombosis ◽

Vena Cava Thrombosis ◽

Magnetic Resonance Imaging Mri

Inferior vena cava (IVC) thrombosis remains under-recognised as it is often not pursued as a primary diagnosis. The aetiology of IVC thrombosis can be divided into congenital versus acquired, with all aetiological factors found among Virchow’s triad of stasis, injury and hypercoagulability. Signs and symptoms are related to aetiology and range from no symptoms to cardiovascular collapse. Painful lower limb swelling combined with lower back pain, pyrexia, dilatation of cutaneous abdominal wall veins and a concurrent rise in inflammatory markers are suggestive of IVC thrombosis. Following initial lower limb venous duplex, magnetic resonance imaging (MRI) is the optimal non-invasive imaging tool. Aetiology directs treatment, which ranges from anticoagulation and lower limb compression to open surgery, with endovascular therapies increasingly favoured. The objective of this review is to assess current literature on the aetiology, presentation, investigation, treatment, prognosis and other factors pertaining to IVC thrombosis.

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