Conus medullaris arachnoid cyst presenting as cauda equina syndrome

Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are complex neurological disorders that can be manifested through a variety of symptoms. Patients may present with back pain, unilateral or bilateral leg pain, paresthesias and weakness, perineum or saddle anesthesia, and rectal and/or urinary incontinence or dysfunction. Although patients typically present with acute disc herniations, traumatic injuries at the thoracolumbar junction at the terminal portion of the spinal cord and cauda equina are also common. Unfortunately, a precise understanding of the pathophysiology and optimal treatments, including the best timing of surgery, has yet to be elucidated for either traumatic CES or CMS. In this paper the authors review the current literature on traumatic conus medullaris and cauda equina injuries and available treatment options.

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A conus medullaris cystic mass causing cauda equina syndrome in a 33-year-old man

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2009.06.005 ◽

2009 ◽

Vol 16 (12) ◽

pp. 1712

Author(s):

Tarkan Ergun ◽

Hatice Lakadamyali

Keyword(s):

Cauda Equina Syndrome ◽

Cauda Equina ◽

Conus Medullaris ◽

Cystic Mass

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Definitions of traumatic conus medullaris and cauda equina syndrome: a systematic literature review

Spinal Cord ◽

10.1038/sc.2017.54 ◽

2017 ◽

Vol 55 (10) ◽

pp. 886-890 ◽

Cited By ~ 6

Author(s):

E Brouwers ◽

H van de Meent ◽

A Curt ◽

B Starremans ◽

A Hosman ◽

...

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Conus Medullaris

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Postoperative cauda equina syndrome in patients undergoing single-level lumbar microdiscectomy

Neurosurgical FOCUS ◽

10.3171/foc.2005.19.2.12 ◽

2005 ◽

Vol 19 (2) ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Vassilios Dimopoulos ◽

Kostas N. Fountas ◽

Theofilos G. Machinis ◽

Carlos Feltes ◽

Induk Chung ◽

...

Keyword(s):

Cauda Equina Syndrome ◽

De Novo ◽

Cauda Equina ◽

Conus Medullaris ◽

Clinical Findings ◽

Magnetic Resonance Images ◽

Single Level ◽

Lumbar Microdiscectomy ◽

First Case ◽

Intraoperative Electrophysiological Monitoring

Cauda equina syndrome is a well-documented complication of uneventful lumbar microdiscectomy. In the vast majority of cases, no radiological explanation can be obtained. In this paper, the authors report two cases of postoperative cauda equina syndrome in patients undergoing single-level de novo lumbar microdiscectomy in which intraoperative electrophysiological monitoring was used. In both patients, the amplitudes of cortical and subcortical intraoperative somatosensory evoked potentials (SSEPs) abruptly decreased during discectomy and foraminotomy. In the first patient, a slow, partial improvement of SSEPs was observed before the end of the operation, whereas no improvement was observed in the second patient. In the first case, clinical findings consistent with cauda equina syndrome were seen immediately postoperatively, whereas in the second one the symptoms developed within 1.5 hours after the procedure. Postoperative magnetic resonance images obtained in both patients, and a lumbar myelogram obtained in the second one revealed no signs of conus medullaris or nerve root compression. Both patients showed marked improvement after an intense course of rehabilitation. The authors' findings support the proposition that intraoperative SSEP monitoring may be useful in predicting the development of cauda equina syndrome in patients undergoing lumbar microdiscectomy. Nevertheless, further prospective clinical studies are necessary for validation of these findings.

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Tethered Cord Syndrome

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.4.42536 ◽

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.

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Clinical, neuroimaging, and nerve conduction characteristics of spontaneous Conus Medullaris infarction

BMC Neurology ◽

10.1186/s12883-019-1566-1 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Yi-Ching Weng ◽

Shy-Chyi Chin ◽

Yah-Yuan Wu ◽

Hung-Chou Kuo

Keyword(s):

Cauda Equina Syndrome ◽

Cauda Equina ◽

Conus Medullaris ◽

Anterior Horn ◽

Case Presentation ◽

Acute Low Back Pain ◽

Long Term Follow Up ◽

Cell Disorder

Abstract Background Spontaneous conus medullaris infarction is a rare disease. We describe two patients with spontaneous conus medullaris infarction presenting as acute cauda equina syndrome and their unique electromyography (EMG) findings. Case presentation Two patients developed acute low back pain with mild asymmetric paraparesis, loss of perianal sensation and sphincter dysfunction. Ankle deep tendon reflexes were reduced in bilaterally. Neither patient had cardiovascular risk factors. Magnetic Resonance imaging showed infarction in the conus medullaris. Functional recovery was good in both patients, but progressive asymmetric calf wasting and sphincter dysfunction remained. EMG studies at follow-up of at least 3 years demonstrate active denervation at the muscles innervated by the first sacrum anterior horn cells. Conclusion Spontaneous conus medullaris infarction can occur in healthy individuals and presents as cauda equina syndrome. Findings of needle EMG studies indicate a progressive course of sacrum anterior horn cell disorder during long-term follow-up.

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Extradural Spinal Arachnoid Cyst as a Cause of Cauda Equina Syndrome in a Child

Korean Journal of Neurotrauma ◽

10.13004/kjnt.2020.16.e35 ◽

2020 ◽

Vol 16 (2) ◽

pp. 355

Author(s):

Kyoung Hwan Yoo ◽

Min Chan Kim ◽

Chang Il Ju ◽

Seok Won Kim

Keyword(s):

Arachnoid Cyst ◽

Cauda Equina Syndrome ◽

Cauda Equina ◽

Spinal Arachnoid Cyst

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Spinal cord ischemia/infarct after cauda equina syndrome from disc herniation – A case study and literature review

Surgical Neurology International ◽

10.25259/sni-148-2019 ◽

2019 ◽

Vol 10 ◽

pp. 80

Author(s):

David C. Kramer ◽

Adela Aguirre-Alarcon ◽

Reza Yassari ◽

Allan L. Brook ◽

Merritt D. Kinon

Keyword(s):

Spinal Cord ◽

Disc Herniation ◽

Cauda Equina Syndrome ◽

Spinal Cord Ischemia ◽

Cauda Equina ◽

Conus Medullaris ◽

Foot Drop ◽

Neurological Deficits ◽

Vascular Lesions ◽

Spinal Cord Infarction

Background: Spinal cord infarction is rare and occurs in 12/100,000; it represents 0.3%–2% of central nervous system infarcts. Here, we present a patient who developed recurrent bilateral lower extremity paraplegia secondary to spinal cord infarction 1 day after a successful L4-5 microdiscectomy in a patient who originally presented with a cauda equina syndrome. Case Description: A 56-year-old patient presented with an acute cauda equina syndrome characterized by severe lower back pain, a right foot drop, saddle anesthesia, and acute urinary retention. When the lumbar magnetic resonance imaging (MRI) revealed a large right paracentral lumbar disc herniation at the L4-L5 level, the patient underwent an emergency minimally invasive right-sided L4-5 discectomy. Immediately, postoperatively, the patient regained normal function. However, 1 day later, while having a bowel movement, he immediately developed the recurrent paraplegia. The new lumbar MRI revealed acute ischemia and an infarct involving the distal conus medullaris. Further, workup was negative for a spinal cord vascular malformation, thus leaving an inflammatory postsurgical vasculitis as the primary etiology of delayed the conus medullaris infarction. Conclusions: Acute neurologic deterioration after spinal surgery which does not neurologically correlate with the operative level or procedure performed should prompt the performance of follow-up MR studies of the neuraxis to rule out other etiologies, including vascular lesions versus infarctions, as causes of new neurological deficits.

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