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

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.

Spine ◽  
1992 ◽  
Vol 17 (12) ◽  
pp. 1469-1473 ◽  
Author(s):  
Scott Haldeman ◽  
Sidney M. Rubinstein

2016 ◽  
Vol 10 (5) ◽  
pp. 945 ◽  
Author(s):  
Simret Singh Randhawa ◽  
Angel Khor Nee Kwan ◽  
Chee Kidd Chiu ◽  
Chris Yin Wei Chan ◽  
Mun Keong Kwan

Author(s):  
Humberto Foyaca-Sibat

ABSTRACT: Background: Cauda equina syndrome secondary (CES) to primary sacral diffuse large B cell lymphoma (DLBCL) is an uncommon condition, and few cases have been reported in the medical literature. After an extensive literature review related to these topics, we did not find a reported case like our patient.


2020 ◽  
pp. 1-2
Author(s):  
Joseph Gamal Boktor ◽  
Joseph Gamal Boktor ◽  
Miriam Nakanda Kakaire ◽  
Ashish Khurana ◽  
Devi Prakash Tokala

Lumbar discectomy is a common procedure for acute disc prolapse, especially in patients with neurological deficit [1]. The literature describes using fluoroscopy intraoperatively to avoid wrong level and side [2]. However, there is no method to confirm/document adequate discectomy apart from a postoperative MRI. The authors' technique involves taking clinical photos of the removed disc material. This technique provides accurate, low-cost documentation, and the patient can review it post-operatively. This could be of significant value in large disc prolapse and cauda equina syndrome surgery.


1992 ◽  
Vol 77 (6) ◽  
pp. 945-948 ◽  
Author(s):  
Richard H. Schmidt ◽  
M. Sean Grady ◽  
Wendy Cohen ◽  
Sanford Wright ◽  
H. Richard Winn

✓ 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.


2016 ◽  
Vol 8 (1) ◽  
pp. 87-91 ◽  
Author(s):  
Amal Alkhotani ◽  
Nouf Alrishi ◽  
M. Salem Alhalabi ◽  
Tahira Hamid

Leptomeningeal carcinomatosis (LMC) is a diffuse or multifocal malignant infiltration of the pia matter and arachnoid membrane. The most commonly reported cancers associated with LMC are breast, lung, and hematological malignancies. Patients with LMC commonly present with multifocal neurological symptoms. We report a case of LMC secondary to gastroesophageal junction cancer present initially with cauda equina syndrome. A 51-year-old male patient with treated adenocarcinoma of the gastroesophageal junction presented with left leg pain, mild weakness, and saddle area numbness. Initial radiological examinations were unremarkable. Subsequently, he had worsening of his leg weakness, fecal incontinence, and urine retention. Two days later, he developed rapidly progressive cranial neuropathies including facial diplegia, sensorineural hearing loss, dysarthria, and dysphagia. MRI with and without contrast showed diffuse enhancement of leptomeninges surrounding the brain, spinal cord, and cauda equina extending to the nerve roots. Cerebrospinal fluid cytology was positive for malignant cells. The patient died within 10 days from the second presentation. In cancer patients with cauda equina syndrome and absence of structural lesion on imaging, LMC should be considered. To our knowledge, this is the first case of LMC secondary to gastroesophageal cancer presenting with cauda equina syndrome.


2009 ◽  
Vol 285 ◽  
pp. S235-S236
Author(s):  
K. Piyatanont ◽  
K. Bamrungrak ◽  
S. Watcharangnan ◽  
B. Sathapatayavongs ◽  
S. Chuncharunee ◽  
...  

2016 ◽  
Vol 16 (9) ◽  
pp. e587-e588
Author(s):  
Ming-Xiang Zou ◽  
Guo-Hua Lv ◽  
Jing Li ◽  
Xiao-Bin Wang

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