scholarly journals Spondylitis Presenting With Cauda Equina Syndrome in a 12 Year Old Boy

2020 ◽  
Vol 28 (1) ◽  
pp. 119-122
Author(s):  
Sukriti Das ◽  
Musannah Ashfaq ◽  
Kaniz Fatema Ishrat Jahan ◽  
Shamsul Islam Khan ◽  
Rakibul Islam ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Muscle Power ◽  
Cauda Equina ◽  
Surgical Excision ◽  
Lower Limbs ◽  
High Dose ◽  
Medical College ◽  
Bladder Control ◽  
History Of ◽  
Antibiotic Regime

A 12-year-old boy presented with a 2-week history of low back pain and 10-day history of weakness of the lower limbs,5-day history of inability to pass urine. An MRI scan of the lumbar spine showed dehiscent lamina of L5,S1 and an epidural abscess. He was admitted to hospital and treated with a high dose of IV antibiotics followed by radical surgical excision of the lesion. Histopathology showed features of abscess. He eventually recovered bowel and bladder control and regained muscle power in the lower limbs. Infection is not a common cause of cauda equina syndrome. Aggressive surgical treatment combined with a prolonged antibiotic regime is recommended to achieve a satisfactory result. J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 119-122

scholarly journals Late presentation of a cauda equina lesion with a vulval abscess: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Chanil Deshan Ekanayake ◽  
Deepal Weerasekera ◽  
Dilini Dissanayake ◽  
Ranga Wickramarachchi ◽  
Saman Pushpakumara ◽  
...  
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Late Presentation ◽  
Surgical Decompression ◽  
Lower Limbs ◽  
Sensory Loss ◽  
Postoperative Rehabilitation ◽  
Indwelling Catheter ◽  
Distended Bladder ◽  
Tract Infections

Abstract Background Cauda equina syndrome is a rare clinical condition that requires prompt diagnosis and timely surgical decompression with postoperative rehabilitation to prevent devastating complications. Case presentation A 55-year-old Sinhalese woman presented with a vulval abscess, with a history of involuntary leakage of urine for the last 7 years. Her sexual activity has been compromised due to coital incontinence, and she had also been treated for recurrent urinary tract infections during the last 7 years. On examination, a distended bladder was found. Neurological examination revealed a saddle sensory loss of S2–S4 dermatomes. There was no sensory loss over the lower limbs. Bladder sensation was absent, but there was some degree of anal sphincter tone. Motor functions and reflexes were normal in the limbs. Magnetic resonance imaging revealed L5–S1 spondylolisthesis. Ultrasound imaging confirmed the finding of a distended bladder, in addition to bilateral hydroureters with hydronephrosis. An incision and drainage with concomitant intravenous antibiotics were started for the vulval abscess. An indwelling catheter was placed to decompress the bladder and to reduce vulval excoriations due to urine. Bilateral ureteric stenting was performed later for persistent hydronephrosis and hydroureter despite an empty bladder. Conclusion This is a tragic case that illustrates the devastating long-term sequelae that ensues if cauda equina syndrome is left undiagnosed. It reiterates the importance of prompt referral and surgical decompression.

Just the facts: Risk stratifying nontraumatic back pain for Cauda Equina Syndrome in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 652-654
Author(s):  
Zoe Polsky ◽  
Margriet Greidanus ◽  
Anjali Pandya ◽  
W. Bradley Jacobs
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Bowel Movement ◽  
Chronic Back Pain ◽  
Cauda Equina ◽  
Digital Rectal Examination ◽  
Acute Onset ◽  
Clinical Exam ◽  
History Of

A 43-year-old male, with a history of chronic back pain, presents to the emergency department (ED) with acute onset chronic pain. He states he “tweaked something” and has been debilitated by back pain, radiating down both his legs, for 24 hours. He has not had a bowel movement but denies noticing any “saddle anesthesia.” His clinical exam is limited by pain, and it is difficult to determine if he has objective weakness. His perineal sensation is intact, as is his sensation upon digital rectal examination. The patient has a post-void residual of 250 mL, but you are unsure how to interpret this value. As an emergency physician, when should you suspect, and how should you evaluate cauda equina syndrome?

scholarly journals Cauda equina syndrome due to Factor Xa inhibitor (Rivaroxaban): Case report and review of literature

2020 ◽  
Vol 7 (1) ◽  
pp. 7
Author(s):  
SR Gowda ◽  
PJ O’Hagan ◽  
JT Griffiths
Keyword(s):  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Factor Xa ◽  
Epidural Haematoma ◽  
Sudden Onset ◽  
Lower Limbs ◽  
Spontaneous Bleeding ◽  
Gradual Improvement ◽  
Spinal Epidural Haematoma ◽  
Spinal Epidural

Background: Factor Xa inhibitors are widely used by the physicians to reduce the incidence of thrombosis in order to protect the cardiovascular function. Although complications of bleeding and spontaneous gastrointestinal sources have been reported before, there are very sporadic cases of spinal epidural haematoma causing neurological compromise. Case presentation: We report a case of spontaneous spinal epidural haematoma (SSEH) in an 85-year-old female patient treated with Rivaroxaban, a new agent to prevent the incidence of thrombo-embolic events. Anticoagulant therapy is a recognised risk factor in the development of spontaneous bleeding and haematomas. The patient presented to the emergency department with sudden onset of severe back pain in the lumbar spine associated with paraplegia in the lower limbs. Magnetic resonance imaging (MRI) of the spine demonstrated a SSEH from T12 to L5 affecting the cauda equina. Rivaroxaban was discontinued and the patient was monitored as an inpatient. There was gradual improvement in the symptoms of the lower limbs. Conclusion: This rare condition of incomplete cauda equina syndrome due to Rivaroxaban therapy has not been reported previously. Clinicians must have a high index of suspicion in patients on regular anti-coagulation regimen.

scholarly journals GELFOAM INDUCED CAUDA EQUINA SYNDROME: A CASE REPORT WITH REVIEW OF LITERATURE

2020 ◽  
pp. 1-3
Author(s):  
Nazim Mughal ◽  
Deepankar Mishra ◽  
Ajay Srivastava ◽  
Nikhat Naaz
Keyword(s):  
Spinal Surgery ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Neurological Complications ◽  
Lumbar Discectomy ◽  
Lower Limbs ◽  
Gelatin Sponge ◽  
Review Of Literature ◽  
Hemostatic Agents ◽  
Dural Sac

Gelatin sponge (Gelfoam) is quite often used for haemostasis during spine surgery. However due to its property of osmotic expansion after coming in contact with blood, it has the potential to cause serious complications as a result of compression of nearby vital neurological tissues. We report a case of cauda equina syndrome due to retained Gelfoam during spinal surgery. A 35 year old female patient presented with complaints of pain and numbness in lower limbs for 5 months. MRI was suggestive of disc herniation at L4/L5. Lumbar discectomy was done and gelfoam was used for haemostasis. However, patient developed post-operative neurological complications suggestive of cauda equina syndrome. MRI showed gelfoam induced compression of dural sac. Gelfoam removal was done after which marked improvement in symptoms was observed. Conclusion: Hemostatic agents like Gelfoam which are often used during surgeries have the potential to cause compression of vital structures. Therefore, these should be removed once haemostatic control is accomplished and if it is to be retained, prompt post operatively monitoring is essential.

scholarly journals 1. TIF1-γ associated dermatomyositis

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Rosemary Waller ◽  
Nadia Ahmad
Keyword(s):  
Conflicts Of Interest ◽  
Case Reports ◽  
Strong Association ◽  
Lung Nodule ◽  
Lower Limbs ◽  
Mediastinal Lymphadenopathy ◽  
Uneventful Recovery ◽  
High Dose ◽  
Shortness Of Breath ◽  
History Of

Abstract Introduction This is a case of a patient presenting at the age of 39 with dermatomyositis. Subsequent investigations revealed her to have a TIFI-γ antibody and a metastatic colon adenocarcinoma. She was initially steroid responsive and her malignancy simultaneously responded to chemotherapy. A relapse of her malignancy was preceded by a flare in her dermatomyositis which proved to be non-responsive to steroids and further chemotherapy. Case description The patient presented to rheumatology at the age of 39 with a few-week history of a photosensitive rash on her face, upper chest and hands. This was followed by rapidly progressive symmetrical proximal and truncal muscle weakness and pain. She described dysphagia to solids and shortness of breath on exertion. She had a very short history of weight loss, attributed to reduced oral intake. She had no relevant past medical history and was taking no medications. Examination revealed power of 3/5 in both upper and lower limbs, a heliotrope rash with Gottrons papules with normal cardiovascular and respiratory examinations. CK at presentation was 3709. Haematology and biochemistry was otherwise normal. MRI thighs showed extensive myositis. ANA was positive with a positive TIFI-γ antibody. CT scan showed a proximal sigmoid mass with local and mediastinal lymphadenopathy and a 6mm lung nodule. Histology from a mediastinal node confirmed a metastatic adenocarcinoma. Initially, the patient was treated as an autoimmue dermatomyositis with pulsed IV methylprednisolone followed by high dose prednisolone. She responded rapidly both clinically and biochemically to steroids. Following the diagnosis of malignancy, she underwent a hemicolectomy from which she made an uneventful recovery. She then completed 12 cycles of oxaliplatin and 5FU chemotherapy, with interval CT scanning showing good partial response to treatment and she returned to work. One month after completing chemotherapy, whilst still taking prednisolone her rash reoccurred. This rapidly progressed despite an increase in her steroids and quickly became associated with weakness and further shortness of breath. CT showed a progression of her malignancy with carcinomatosis lymphangiitis. She received one cycle of Irinotecan before being admitted with neutropenic sepsis and progression of her cancer. At this time she decided to withdraw all treatment and died shortly afterwards at the age of 40, 18 months after her initial presentation. Discussion TIF1-γ antibodies were first identified in 2006 and are involved in cell regeneration, apoptosis and innate immunity. High levels of TIFI-Y are found in the nuclei of regenerating myofibres. They are associated with dermatomyositis and are found in between 13 – 31% of adults and 22 – 29% of children. There is a strong association with malignancy in those aged over 39 (positive predictive value of 58%, sensitivity 78%, specificity 89%). There are no case reports of malignancy associated with TIF1- Y antibodies in patients under the age of 39. Malignancy typically presents early in the course of dermatomyositis, being diagnosed at presentation or within 8 months. There are case reports of TIF1- Y antibodies co-existing with Mi2 antibodies, increasing malignancy risk. In younger patients this association with cancer is not seen but the antibody is associated with skin ulceration and chronic disease. It is hypothesised that differences in HLA regions and protein conformation may account for these different phenotypes. Patients typically have a lower CK and there is a higher incidence of amyopathic dermatomyositis compared with other myositis specific antibodies. Our patient was at the lower end of the risk spectrum for malignancy and had no localising symptoms for this. She was initially very steroid responsive, which again lowered our threshold for suspicion of malignancy. Indeed, her CT was requested on the basis of shortness of breath looking for interstitial lung disease rather than anything more sinister. Key learning points TIF1-γ antibodies have a strong association with malignancy in patients over the age of 39. Clinicians should have a high index of suspicion even in the absence of symptoms of malignancy. Malignancy associated dermatomyositis can be steroid responsive. A relapse of dermatomyositis should raise suspicion for a relapse of malignancy. Conflicts of interest The authors have declared no conflicts of interest.

scholarly journals Massive prosthetic aortic abscess: an overarching plight 7 years post-Bentall’s procedure

2019 ◽  
Vol 12 (9) ◽  
pp. e230204
Author(s):  
Michael McCann ◽  
Nikki Stamp ◽  
Robert Larbalestier
Keyword(s):  
Surgical Intervention ◽  
Aortic Surgery ◽  
Surgical Excision ◽  
High Dose ◽  
Rapid Progression ◽  
Redo Surgery ◽  
Aortic Arch Replacement ◽  
Urgent Surgery ◽  
Initial Surgery ◽  
History Of

Infections of proximal aortic vascular grafts are a catastrophic complication of aortic surgery. Despite aggressive antimicrobial and surgical intervention, mortality and reinfection rates remain significant. Here, we describe a man aged 71 years with a medical history of bioprosthetic aortic valve with aortic arch replacement (modified Bentall’s procedure), who developed a large periprosthetic abscess due to Staphylococcus aureus 7 years after his initial surgery. The patient’s preference was to avoid redo surgery, however despite high-dose intravenous flucloxacillin and oral rifampicin therapy, there was rapid progression of the abscess, necessitating urgent surgery. Notwithstanding the burden of infection, the patient underwent successful surgical excision and graft re-implantation and remains independent and well, almost 2 years postoperatively.

scholarly journals Management of Cauda Equina Syndrome: NHS Staff Perceptions in a DGH

2020 ◽  
Vol 4 (2) ◽  
pp. 1-10
Author(s):  
G Taylor
Keyword(s):  
Cauda Equina Syndrome ◽  
Empirical Studies ◽  
Cauda Equina ◽  
Nominal Group Technique ◽  
Lower Limbs ◽  
Nominal Group ◽  
Poor Correlation ◽  
Mri Findings ◽  
Staff Perceptions ◽  
Validated Questionnaire

Objective: Cauda Equina Syndrome (CES) is a challenging condition to diagnose due to such variability in clinical features and poor correlation with MRI findings. It requires surgery within hours to avoid damage to the bowel, bladder, sexual organs and lower limbs. There are empirical studies exploring patients’ perspectives of having CES, however, there is no literature to review NHS staff perceptions of managing this neurosurgical emergency. The aim is to explore perceptions of senior clinical staff who commonly manage patients with suspected CES in secondary care within the Emergency Department (ED) and Trauma and Orthopaedics (T&O) to improve the management of CES. The main objective is to identify barriers to successful management and possible solutions to improve care. Methods: A self-administered non-validated questionnaire was designed to identify barriers experienced and potential solutions. In addition, a Nominal Group Technique (NGT) was used to gain a greater insight. The qualitative data obtained was analysed by thematic analysis. Results: The questionnaire generated a 73% response rate. Six senior clinicians attended the NGT with representation from the three clinical specialities; ED, T&O and Advanced Physiotherapy Practitioner (APP). The challenges and potential solutions were categorised into themes and subthemes. The barriers highlighted included; staff confidence in clinical diagnosis; fear of litigation and inter-professional relations; patient psychosocial factors, expectations and comorbidities; lack of agreed local pathway. The solutions raised include; staff training; standardising local/national pathway; access to daily Magnetic Resonance Imaging (MRI) slots. Conclusion: Patient safety and accurate diagnosis of CES is at the forefront of decision-making despite organisation barriers and limitations of existing pathways. A shift away from admission to expedite an urgent MRI requires a change to traditional clinical practice and expectations. In times of rising pressures and financial constraints, collaborative working is essential to implement and sustain the required changes highlighted in this study.

scholarly journals Posterior epidural migration of a lumbar disc herniation

2020 ◽  
Vol 11 ◽  
pp. 4
Author(s):  
Meryem Himmiche ◽  
Khalid Chakour ◽  
Mohammed El Faiz Chaoui ◽  
Mohammed Benzagmout
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Low Back ◽  
Case Description ◽  
Disc Material ◽  
Disc Herniations ◽  
History Of

Background: Posterior epidural migration of a lumbar disc fragment (PEMLDF) refers to the dorsal migration of disc material around the thecal sac that can lead to radiculopathy and/or cause a cauda equina syndrome. It is rare and the diagnosis is often just established intraoperatively. Case Description: A 50-year-old male with a chronic history of low back pain and psychosis presented with PEMLDF originating at the L4–L5 level. Conclusion: Lumbar disc herniations rarely present as PEMLDF resulting in symptoms varying from radiculopathy to cauda equina syndrome. These should be included among the differential diagnostic considerations for dorsolateral epidural lesions.

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.

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