scholarly journals Ectopic ganglion in cauda equina: case report

2016 ◽  
Vol 24 (6) ◽  
pp. 937-940
Author(s):  
Andrew K. Conner ◽  
Kar-Ming Fung ◽  
Jo Elle G. Peterson ◽  
Chad A. Glenn ◽  
Michael D. Martin
Keyword(s):  
Urinary Incontinence ◽  
Case Report ◽  
Spinal Dysraphism ◽  
Cauda Equina ◽  
Pathological Finding ◽  
Clinical Findings ◽  
Leg Pain ◽  
Open Biopsy ◽  
History Of ◽  
Space Occupying Lesion

Macroscopic ectopic or heterotopic ganglionic tissue within the cauda equina is a very rare pathological finding and is usually associated with spinal dysraphism. However, it may mimic genuine neoplasms of the cauda equina. The authors describe a 29-year-old woman with a history of back pain, right leg pain, and urinary incontinence in whom imaging demonstrated an enhancing mass located in the cauda equina at the L1–2 interspace. The patient subsequently underwent biopsy and was found to have a focus of ectopic ganglionic tissue that was 1.3 cm in greatest dimension. To the authors' knowledge, ectopic or heterotopic ganglionic tissue within the cauda equina in a patient without evidence of spinal dysraphism has never been reported. This patient presented with imaging and clinical findings suggestive of a neoplasm, and an open biopsy proved the lesion to be ectopic ganglionic tissue. The authors suggest that ectopic ganglionic tissue be added to the list of differential diagnoses of a space-occupying lesion arising from the cauda equina.

scholarly journals Case Report of Isolated Hepatic Tuberculosis

2015 ◽  
Vol 26 (1) ◽  
pp. 43-45 ◽  
Author(s):  
Mohammad Rafiqul Islam ◽  
Maria Maksud ◽  
Prianka Baral ◽  
Mahbub Hossain ◽  
Ahmedul Kabir
Keyword(s):  
Case Report ◽  
Clinical Manifestations ◽  
Common Disease ◽  
Pulmonary Tb ◽  
Common Diseases ◽  
Hepatic Tuberculosis ◽  
History Of ◽  
Space Occupying Lesion

Tuberculosis is one of the most common diseases in Bangladesh and has variable clinical manifestations. Isolated Hepatic tuberculosis is not a common disease; in fact the presentation of hepatic tuberculosis may be without having history of any active Pulmonary TB or military TB. Patient usually present without having any typical symptoms; so it is difficult for a physician to diagnose the disease quickly. Patient presenting with space occupying lesion in liver is confused with abscess, hepatoma or metastases. Here we are presenting a case report of isolated hepatic tuberculosis.Bangladesh J Medicine Jan 2015; 26 (1) : 43-45

scholarly journals Treatment of lumbar vertebra epithelioid hemangioma with radiation therapy: a case report

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Aldis P. Siltumens ◽  
Na L. Smith ◽  
Rosalind F. Sharain ◽  
Michael G. Haddock ◽  
W. Michael Hooten
Keyword(s):  
Radiation Therapy ◽  
Back Pain ◽  
Case Report ◽  
Case Series ◽  
Leg Pain ◽  
Bone Lesions ◽  
Low Back ◽  
Epithelioid Hemangioma ◽  
History Of ◽  
Effects Of Radiation

Abstract Background Although epithelioid hemangiomas involving bone have been described in previous case reports and case series, the effects of radiation therapy on vertebral epithelioid hemangioma has not been fully reported. Here we provide a case report of tumor response to radiation therapy in a young adult with a large epithelioid hemangioma involving the fourth lumbar vertebrae. Case presentation A 27-year-old Latino man with a past medical history of type 1 diabetes and a 3-year history of low back pain presented to a hospital emergency department following acute worsening of back pain. On transfer to our tertiary medical center, he described the pain as “shock-like” which originated at the lateral aspect of his right hip and radiated down to his right knee. Paresthesia was also reported along the medial aspect of his lower right leg. Imaging included a computed tomography scan and magnetic resonance imaging which revealed fourth lumbar and right iliac lytic bone lesions. Image-guided biopsies of the lytic lesions were consistent with a diagnosis of epithelioid hemangioma and radiation therapy was recommended as the primary treatment. Our patient’s low back and leg pain were initially managed with acetaminophen, oxycodone, pregabalin, and lidocaine patch 5%. He noted improvement in pain after his third fraction of radiation. Pain intensity continued to decline and oxycodone was discontinued. Conclusions This case report demonstrates an unusual etiology of back and leg pain in a young man and elucidates the palliative effects of radiation therapy for epithelioid hemangioma involving the lumbar spine.

scholarly journals Retained Surgical Items in Inguinal Canal: A Case Report and Literature Review

2018 ◽  
Vol 6 (11) ◽  
pp. 2165-2167
Author(s):  
Amer Hashim Al Ani ◽  
Mohammad Bakri Hammami ◽  
Obaidah M. Mukhles Adi
Keyword(s):  
Case Report ◽  
Inguinal Hernia ◽  
Literature Review ◽  
Hernia Repair ◽  
Preventive Measures ◽  
Inguinal Canal ◽  
Elective Surgery ◽  
Clinical Findings ◽  
History Of ◽  
High Index Of Suspicion

BACKGROUND: Retained surgical items (RSI) are rare medical challenges with serious complications and medicolegal implications. Knowledge and preventive measures for these rare events are currently not sufficient to limit their increasing incidence. Gauzes and sponges constitute most of RSI. Forceps, needles and pins may be found too. Diagnosis of these events is challenging and often missed due to nonspecific clinical findings. PRESENTATION OF CASE: We present here a 49-year-old patient who presented to the clinic with a history of chronic scrotal sinus on the same side of a repeatedly repaired inguinal hernia 4 months before admission. He underwent exploration of the inguinal canal as elective surgery. Exploration of the inguinal canal revealed missed surgical gauze left during the previous hernia repair. The gauze was removed, and the inguinal canal was repaired. The postoperative period was uncomplicated. CONCLUSION: Retained surgical items are completely preventable near-events. Although they are rare entities, clinicians must have a high index of suspicion for any postoperative, in patients presenting with pain, sinus or palpable masses.

scholarly journals Lingual thyroid causing dysphonia: case report

2004 ◽  
Vol 122 (2) ◽  
pp. 67-69 ◽  
Author(s):  
Alfio José Tincani ◽  
Antonio Santos Martins ◽  
André Del Negro ◽  
Priscila Pereira Costa Araújo ◽  
Gilson Barretto
Keyword(s):  
Case Report ◽  
Thyroid Gland ◽  
Upper Airway ◽  
Surgical Excision ◽  
Clinical Findings ◽  
Ectopic Thyroid ◽  
Lingual Thyroid ◽  
Recurrent Hemorrhage ◽  
Appropriate Treatment ◽  
History Of

CONTEXT: Lingual thyroid gland is a rare clinical entity that is caused by the failure of the thyroid gland to descend to a normal cervical location during embryogenesis. The occurrence of an ectopic thyroid gland located at the base of the tongue may cause problems for the patient, with symptoms of dysphagia, dysphonia, upper airway obstruction or even hemorrhage at any time from infancy through adulthood. CASE REPORT: We report on a case of lingual thyroid gland in a 41-year-old female patient. The embryology and diagnosis of ectopic thyroid are discussed and its management is outlined. Features of the diagnostic and therapeutic evaluation are described with attention to the clinical findings, laboratory tests, thyroid scan and computed tomography imaging studies employed in the confirmation of diagnosis and planning of appropriate treatment. The history of the condition is reviewed and a treatment strategy is outlined. Surgical excision of the gland is reserved for cases of gland enlargement that result in compromised airways (dysphagia or dysphonia) or recurrent hemorrhage.

scholarly journals Elusive Diagnosis of Superficial Peroneal Nerve Entrapment (Case Report)

2020 ◽  
Author(s):  
Róbert Rapčan ◽  
Ladislav Kočan ◽  
Håkan Alfredson ◽  
Rudolf Sudzina ◽  
Simona Rapčanová ◽  
...  
Keyword(s):  
Case Report ◽  
Lower Limb ◽  
Peroneal Nerve ◽  
Clinical Findings ◽  
Leg Pain ◽  
Clinical State ◽  
Superficial Peroneal Nerve ◽  
Rare Type ◽  
Lateral Muscle ◽  
Common Diagnosis

Isolated neuropathy of the superficial peroneal nerve (SPN) is a relatively rare type of peripheral neuropathy. It is linked to the mechanical entrapment of the SPN in predisposed locations of its anatomical pathway. Associated clinical findings are insufficient lifting of the latero-dorsal part of the foot, stepping on the lateral border of the foot, and commonly, a strong pain localized in the nerve dermatome.Case report. We describe a case of a 14-year-old female patient with right leg pain lasting 24 months. Repeated neurological examinations with negative findings on electromyography (EMG) were performed. The patient underwent a Steindler surgery for a suspected diagnosis of a heel spur, without any improvement. Despite complex pharmacotherapy, chronic pain developed. The patient was unable to walk, being bound to a wheelchair. Amputation of her lower limb under the knee was also considered. SPN entrapment was diagnosed at a physical examination at EuroPainClinics. Decompression of the SPN under local anaesthesia was performed at the clinic.Results. The symptoms improved immediately after the procedure, and following 2 months of rehabilitation, the patient was completely symptom-free. Her clinical state remains unchanged until this day.Conclusions. SPN entrapment is not a common diagnosis in the group of pain syndromes. Regarding the lower limb, it is imperative to include it on the list of differential diagnoses in cases of pain and functional disorders of the lateral muscle groups of the calf and leg. In the case of SPN entrapment, EMG findings may be negative.

scholarly journals Flexible endoscope visualization to assist in the removal of a string of 10 schwannomas at the cauda equina: technical case report

2020 ◽  
Vol 33 (5) ◽  
pp. 688-691 ◽  
Author(s):  
Yu-Cheng Ren ◽  
Bin-Jie Zhao ◽  
Zhi-Yi Xie ◽  
Guang-Yu Ying ◽  
Fang Shen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Spinal Canal ◽  
Cauda Equina ◽  
Flexible Endoscope ◽  
Leg Pain ◽  
Invasive Technique ◽  
Invasive Approach ◽  
Postoperative Mri ◽  
History Of ◽  
The Relationship

Bead-like schwannomas at the cauda equina are rare but benign intraspinal tumors. They can involve multiple nerve roots and spread within the spinal canal, and open resection would cause significant trauma. The authors have successfully applied a novel minimally invasive technique for the total removal of such schwannomas. A 68-year-old woman presented with a 1-month history of left waist and leg pain. MRI demonstrated multiple intraspinal lesions located from L1 to S1. The diagnosis was bead-like schwannomas at the cauda equina. Two incisions were made at the T12 and L5 levels. A flexible endoscope was introduced into the spinal canal following hemisemilaminectomy under a microscope to identify the relationship between the tumors and the carrying nerves. After dissecting both cranial and caudal ends of the carrying nerve, the string of bead-like tumors was gently pulled out from the caudal end as a whole. The endoscope was reintroduced into the spinal canal to ensure complete tumor removal. The patient recovered quickly, and no tumor residual was found at postoperative MRI. Flexible endoscope–assisted visualization plus microscopic hemisemilaminectomy via 2 incisions is a feasible minimally invasive approach for selected patients with bead-like schwannomas at the cauda equina.

scholarly journals Intradural iatrogenic epidermoid cyst at cauda equina: A case report

2020 ◽  
Vol 11 ◽  
pp. 299
Author(s):  
Jose Javier Cuellar Hernandez ◽  
Miracle Anokwute ◽  
Silvia Judith Hernandez Martinez ◽  
Jose Ramon Olivas
Keyword(s):  
Epidermoid Cyst ◽  
Spinal Dysraphism ◽  
Cauda Equina ◽  
Lower Extremity Weakness ◽  
Epidermoid Cysts ◽  
History Of ◽  
Motor Strength ◽  
Stratified Squamous Epithelium ◽  
The Right ◽  
Spinal Epidural

Background: Spinal epidermoid accounts for <1% of all primary spinal cord tumors. They occur due to the invagination of epidermal elements into the neural tube during the embryonic period. Even more infrequent are spinal epidermoid cysts that occur without attendant spinal dysraphism (e.g., as occurs with the iatrogenic inoculation of epithelial cells in the subarachnoid space following a lumbar puncture). Case Description: A 38-year-old female with a history of epidural spinal blocks at L2-3 for two previous pregnancies presented with low back pain, right lower extremity weakness (4/5 level), hyporeflexia, and tingling/ numbness in the right L3-5 distribution. The lumbar MR demonstrated an intradural extramedullary lesion at the L2-L3 level that compressed the cauda equina/nerve roots. MR findings were compatible with an epidermoid cyst, this was histologically confirmed following a microsurgical L2-3 laminectomy for lesion resection. Pathologically, the lesion demonstrated a keratinized stratified squamous epithelium with keratin content without cutaneous attachments, thus confirming the diagnosis of an epidermoid cyst. Postoperatively, her sensory complains improved and her motor strength fully recovered to the 5/5 level. Conclusion: Patients with spinal epidermoid cysts typically present with underlying spinal dysraphism, but only rarely do iatrogenic cases arise. Here, we presented a patient who developed a spinal lumbar epidermoid cyst in a female patient after undergoing spinal epidural anesthesia during pregnancy. Notably, this was successfully treated a with decompressive laminectomy and microsurgical resection.

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.

scholarly journals Current concepts and recent advances in understanding and managing lumbar spine stenosis

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 137 ◽  
Author(s):  
Carlos Bagley ◽  
Matthew MacAllister ◽  
Luke Dosselman ◽  
Jessica Moreno ◽  
Salah G Aoun ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Cauda Equina ◽  
Work Force ◽  
Clinical Findings ◽  
Current Data ◽  
Leg Pain ◽  
Active Lifestyle ◽  
Level I ◽  
Lumbar Spinal ◽  
The Impact

Lumbar spinal stenosis is a degenerative process that is extremely frequent in today’s aging population. It can result in impingement on the nerves of the cauda equina or on the thecal sac itself, and lead to debilitating symptoms such as severe leg pain, or restriction in the perimeter of ambulation, both resulting in dependency in daily activities. The impact of the disease is global and includes financial repercussions because of its involvement in the active work force group. Risk factors for the disease include some comorbidities such as obesity or smoking, daily habits such as an active lifestyle, but also genetic factors that are not completely elucidated yet. The diagnosis of lumbar stenosis can be difficult, and involves a combination of radiological and clinical findings. Treatment ranges from conservative measures with physical therapy and core strengthening, to steroid injections in the facet joints or epidural space, to a more radical solution with surgical decompression. The evidence available in the literature regarding the causes, diagnosis and treatment of lumbar spine stenosis can be confusing, as no level I recommendations can be provided yet based on current data. The aim of this manuscript is to provide a comprehensive and updated summary to the reader addressing the multiple aspects of this disease.

scholarly journals A Case Report of Chilblain Lupus Erythematosus in a Young Male with Literature Review

2020 ◽  
Vol 4 (1) ◽  
pp. 85-91
Author(s):  
Azib Shahid ◽  
Fatima Iftikhar ◽  
Katherine Glaser ◽  
Anthony Fernandez
Keyword(s):  
Case Report ◽  
Lupus Erythematosus ◽  
Treatment Initiation ◽  
Cutaneous Lupus Erythematosus ◽  
Young Male ◽  
Clinical Findings ◽  
History Of ◽  
Sporadic Disease ◽  
Chilblain Lupus ◽  
Made In

Chilblain lupus erythematosus (CHLE), also known as Hutchinson lupus, is rare form of chronic cutaneous lupus erythematosus. The diagnosis is made in patients with clinical findings of chilblains in conjunction with the clinical or laboratory features of cutaneous or systemic lupus erythematosus (SLE). Similar to idiopathic chilblains (or perniosis), CHLE presents with tender, reddish-blue papules, nodules, or plaques on the toes, fingers, nose, or ears which are precipitated by cold exposure. There is a variation in lab findings that become positive in these patients ranging from a positive Antinuclear antibody (ANA), Rheumatoid factor (RF), SSA/Ro autoantibodies. Anemia, hypocomplementemia, other autoantibodies and elevated ESR have also been described in numerous patients Sporadic disease commonly affects middle-aged women whilst familial disease manifests in childhood. We report herein, a case of CHLE in a young male with no family history of lupus and a negative ANA on initial evaluation. There is little in the published literature on CHLE. This case report serves to revisit the diagnosis of CHLE and review the existing literature. Clinicians should understand the importance of early diagnosis and prompt treatment initiation in order to reduce associated morbidity and possible disfigurement.

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