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.

Posterior epidural migration of sequestered lumbar disc fragments

1999 ◽  
Vol 90 (2) ◽  
pp. 264-266 ◽  
Author(s):  
Pierre Robe ◽  
Didier Martin ◽  
Jacques Lenelle ◽  
Achille Stevenaert
Keyword(s):  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Contrast Material ◽  
Cauda Equina ◽  
Radicular Pain ◽  
Content Type ◽  
Diagnostic Pitfalls ◽  
Fine Print

✓ The posterior epidural migration of sequestered lumbar disc fragments is an uncommon event. The authors report two such cases in which patients presented with either intense radicular pain or cauda equina syndrome. The radiological characteristics were the posterior epidural location and the ring enhancement of the mass after injection of contrast material. The major diagnostic pitfalls are discussed.

Ankylosing spondylitis: cauda equina syndrome with multiple spinal arachnoid cysts

1971 ◽  
Vol 34 (2) ◽  
pp. 241-243 ◽  
Author(s):  
Wolf Rosenkranz
Keyword(s):  
Ankylosing Spondylitis ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Arachnoid Cysts ◽  
Content Type ◽  
Neural Canal ◽  
Fine Print

✓ A case of ankylosing spondylitis in a patient with a cauda equina syndrome is reported. A lumbar myelogram revealed erosions of the bones of the neural canal with enclosed multiple intraspinal cysts.

scholarly journals Functional Outcome After Resection of Von Hippel-Lindau Disease-Associated Cauda Equina Hemangioblastomas: An Observational Cohort Study

2017 ◽  
Vol 13 (4) ◽  
pp. 435-440 ◽  
Author(s):  
Gautam U. Mehta ◽  
Blake K. Montgomery ◽  
Dominic M. Maggio ◽  
Prashant Chittiboina ◽  
Edward H. Oldfield ◽  
...  
Keyword(s):  
Nerve Root ◽  
Motor Nerve ◽  
Therapeutic Option ◽  
Cauda Equina ◽  
Signs And Symptoms ◽  
Vascular Supply ◽  
Complete Resection ◽  
Von Hippel Lindau ◽  
Nerve Fascicle

Abstract BACKGROUND: Cauda equina hemangioblastomas in von Hippel-Lindau (VHL) disease can cause significant neurological signs and symptoms. Despite their associated morbidity, the management of these tumors remains incompletely defined. OBJECTIVE: To determine optimal management, we analyzed the functional outcomes after resection of these tumors. METHODS: VHL patients who underwent surgical resection of cauda equina hemangioblastomas at the National Institutes of Health and the University of Virginia were included. Clinical and radiological follow-up was performed at 6- to 12-month intervals after surgery. RESULTS: Fifteen patients underwent 18 operations for 21 cauda equina hemangioblastomas (median follow-up 5.9 years). Patients often presented with multiple symptoms, including pain (67%), numbness (50%), urinary complaints (33%), and weakness (11%). Median preoperative tumor volume was 1.2 cm3. Four tumors at 3 operations were not resected due to a motor nerve root origin. Gross total resection was achieved in 14 surgeries (93% of operations when resection was attempted). New mild (non-function limiting) neurological symptoms were noted after 11 operations (61%), which most often (64%) resolved within 2 weeks of surgery. At 6-month follow-up, 15 patients (83%) were stable, 2 (11%) were improved, and 1 (6%) was worse. Histological analysis revealed that all tumors originated from within the involved nerve fascicle. CONCLUSIONS: VHL-associated cauda equina hemangioblastomas have an intrafascicular origin and require interruption of the rootlet of origin for complete resection. Motor nerve root involvement may preclude complete resection but strategies including bony decompression and/or interruption of vascular supply may provide a therapeutic option. Nevertheless, most VHL patients with symptom-producing lesions improve with resection.

Endovascular trapping of giant serpentine aneurysms by using Guglielmi detachable coils. Successful reduction of mass effect

2001 ◽  
Vol 94 (5) ◽  
pp. 836-840 ◽  
Author(s):  
Goro Otsuka ◽  
Shigeru Miyachi ◽  
Takashi Handa ◽  
Makoto Negoro ◽  
Takeshi Okamoto ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Therapeutic Option ◽  
Complex Structure ◽  
Mass Effect ◽  
Collateral Flow ◽  
Guglielmi Detachable Coils ◽  
Content Type ◽  
Effective Therapeutic Option ◽  
Detachable Coils ◽  
The Right

✓ Giant serpentine aneurysms (GSAs) are defined as partially thrombosed giant aneurysms with persistent serpentine vascular channels. Surgical management of these rare lesions is difficult because of their large size, complex structure, and unique hemodynamics. The authors report two cases of patients harboring GSAs with mass effect, which were managed effectively with endovascular treatment. The first patient was a 48-year-old man who presented with left homonymous hemianopsia caused by a GSA involving the terminal portion of the right internal carotid artery. The second patient, a 10-year-old boy, presented with tetraparesis from compression of the cervicomedullary junction by a GSA of the right vertebral artery. In each case, after confirming collateral flow by temporarily occluding the proximal artery, the aneurysm was trapped by placement of Guglielmi detachable coils at the sites at which the serpentine channels entered and exited the aneurysm. The midportion of each channel was isolated completely without packing, to maximize resorption of the devascularized mass. Mass effect and clinical symptoms rapidly improved in both cases, with no associated morbidity. We recommend endovascular trapping as a safe and effective therapeutic option for GSAs.

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 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.

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

2012 ◽  
Vol 16 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Mayshan Ghiassi ◽  
Mahan Ghiassi ◽  
Elyne Kahn ◽  
Luke Tomycz ◽  
Michael Ayad ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Cauda Equina Syndrome ◽  
Inferior Vena ◽  
Cauda Equina ◽  
Vena Cava ◽  
Signs And Symptoms ◽  
Surgical Decompression ◽  
Steroid Administration ◽  
Initial Improvement ◽  
Full Neurological Recovery

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.

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.

scholarly journals Tethered Cord Syndrome

2019 ◽  
Vol 3 (3) ◽  
pp. 297-298
Author(s):  
Shawn Catmull ◽  
John Ashurst
Keyword(s):  
Spinal Cord ◽  
Emergency Department ◽  
Emergency Physician ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Tethered Cord ◽  
Signs And Symptoms ◽  
Conus Medullaris ◽  
Tethered Spinal Cord ◽  
Sensory Dysfunction

Tethered spinal cord syndrome refers to signs and symptoms of motor and sensory dysfunction related to increased tension on the spinal cord due to its abnormal attachment; it has classically been associated with a low-lying conus medullaris. Treatment is primarily surgical and has varying degrees of results. Although rarely diagnosed in the emergency department, the emergency physician must be aware of the disease in patients presenting with signs and symptoms concerning for cauda equina syndrome.

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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