Acute piriformis syndrome mimicking cauda equina syndrome: illustrative case

BACKGROUND This report depicts a rare case of acutely developed urinary retention as well as sensory and motor disturbances caused by formation of a large hematoma within the piriformis muscle, which caused compression of nerves within the suprapiriform and infrapiriform foramina, thus imitating cauda equina syndrome. Although cases of acute lumbosacral plexopathy have been described, this case is the first time both urinary retention and sensory and motor disturbances were present. OBSERVATIONS The most useful tools for diagnosis of acute piriformis syndrome are detailed patient history, magnetic resonance imaging (MRI) of the pelvic region, and electrophysiological testing performed by an experienced electrophysiologist. As a result of diligent rehabilitation, including physiotherapy and electrostimulation, the patient was able to successfully recover, regardless of acute compression of the sacral plexus that lasted 6 days. LESSONS Clinicians should actively ask about previous pelvic trauma when taking a patient history in similar cases, especially if the patient is receiving anticoagulation treatment. If MRI of the lumbar spine does not reveal any pathologies, MRI of the pelvic region should be performed. Acute surgical decompression is crucial for preserving neurological function. In similar cases, it is possible to differentiate between spinal cord, cauda equina, and pelvic lesions using electrophysiological studies.

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Corrigendum to “What is the diagnostic accuracy of red flags related to cauda equina syndrome (CES), when compared to Magnetic Resonance Imaging (MRI)? A systematic review” [Musculoskelet. Sci. Pract. 42 (2019) 125–133]

Musculoskeletal Science and Practice ◽

10.1016/j.msksp.2019.07.001 ◽

2019 ◽

Vol 43 ◽

pp. 128

Author(s):

Nathalie Dionne ◽

Abiodun Adefolarin ◽

Dena Kunzelman ◽

Nitin Trehan ◽

Laura Finucane ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Systematic Review ◽

Magnetic Resonance ◽

Diagnostic Accuracy ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Red Flags ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri

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

Medicinski pregled ◽

10.2298/mpns1108419j ◽

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.

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

Surgical Neurology International ◽

10.25259/sni_400_2020 ◽

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.

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Traumatic sacral dermoid cyst rupture with intracranial subarachnoid seeding of lipid particles: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21355 ◽

2021 ◽

Vol 2 (24) ◽

Keyword(s):

Systematic Review ◽

Dermoid Cyst ◽

Cauda Equina ◽

Illustrative Case ◽

Fat Deposits ◽

Mri Scans ◽

Life Threatening ◽

Magnetic Resonance Imaging Mri ◽

Sacral Canal ◽

Cyst Rupture

BACKGROUND Intracranial deposits of fat droplets are an unusual presentation of a spinal dermoid cyst after spontaneous rupture and are even more uncommon after trauma. Here, the authors present a case with this rare clinical presentation, along with a systematic review of the literature to guide decision making in these patients. OBSERVATIONS A 54-year-old woman with Lynch syndrome presented with severe headache and sacrococcygeal pain after a traumatic fall. Computed tomography of the head revealed multifocal intraventricular and intracisternal fat deposits, which were confirmed by magnetic resonance imaging (MRI) of the neuroaxis; in addition, a ruptured multiloculated cyst was identified within the sacral canal with proteinaceous/hemorrhagic debris, most consistent with a sacral dermoid cyst with rupture into the cerebrospinal fluid (CSF) space. An unruptured sacral cyst was later noted on numerous previous MRI scans. In our systematic review, we identified 20 similar cases, most of which favored surgical treatment. LESSONS Rupture of an intraspinal dermoid cyst must be considered when intracranial fat deposits are found in the context of cauda equina syndrome, meningism, or hydrocephalus. Complete tumor removal with close postoperative follow-up is recommended to decrease the risk of complications. CSF diversion must be prioritized if life-threatening hydrocephalus is present.

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Comment on “Cauda equina syndrome: an uncommon cause of urinary retention in a young woman”

International Urogynecology Journal ◽

10.1007/s00192-016-3095-4 ◽

2016 ◽

Vol 27 (10) ◽

pp. 1613-1613

Author(s):

Xueming Wu ◽

Xiaojian Ye

Keyword(s):

Urinary Retention ◽

Young Woman ◽

Cauda Equina Syndrome ◽

Cauda Equina

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

BJS Open ◽

10.1093/bjsopen/zrab032.030 ◽

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.

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The Value of Interhospital Transfer and Emergency MRI for Suspected Cauda Equina Syndrome: A 2-Year Retrospective Study

Annals of The Royal College of Surgeons of England ◽

10.1308/003588408x301154 ◽

2008 ◽

Vol 90 (6) ◽

pp. 513-516 ◽

Cited By ~ 19

Author(s):

M Crocker ◽

G Fraser ◽

E Boyd ◽

J Wilson ◽

BP Chitnavis ◽

...

Keyword(s):

Cauda Equina Syndrome ◽

Cauda Equina ◽

Pain Syndrome ◽

Working Hours ◽

Out Of Hours ◽

Interhospital Transfer ◽

Mri Scans ◽

Prolapsed Intervertebral Disc ◽

Magnetic Resonance Imaging Mri ◽

The Uk

INTRODUCTION The timing of surgery in cauda equina syndrome due to prolapsed intervertebral disc remains controversial. Assessment of these patients requires magnetic resonance imaging (MRI), which is of limited availability outside normal working hours in the UK. PATIENTS AND METHODS We reviewed radiological results in all patients undergoing emergency MRI within our unit for suspected cauda equina syndrome over a 2-year period, and all subjects undergoing emergency lumbar discectomy for cauda equina syndrome within the same period. Outcome measures were: proportion of positive findings in symptomatic patients and proportion of patients referred with diagnostic MRI scans undergoing emergency surgery. We also assessed outcomes of patients having surgery for cauda equina syndrome in terms of improvement of pain, sensory and sphincter disturbance. RESULTS A total of 76 patients were transferred for assessment and ‘on-call’ MRI; 27 were subsequently operated upon. Only 5 proceeded to emergency discectomy that night (prior to next scheduled list). This may be due to delays in timing – from referral to acceptance, to arrival in the department, to diagnostic scan and to theatre. With the second group of patients, 43 had emergency discectomy for cauda equina syndrome during the study period. Of these, 6 patients had an out-of-hours MRI at our hospital for assessment (one patient living locally). Most surgically treated patients experienced improvement in their pain syndrome, with approximately two-thirds experiencing improvement in sensory and sphincter disturbance. CONCLUSIONS These data support a policy of advising MRI scan for cauda equina syndrome at the earliest opportunity within the next 24 h in the referring hospital, rather than emergency transfer for diagnostic imaging which has a relatively low yield in terms of patients operated on as an emergency.

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