Intradural Intraneural Hemorrhagic Cyst Resulting in Progressive Cauda Equina Syndrome After Anticoagulation Therapy
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Abstract:
Case report.To report a case of lumbar intraneural hemorrhagic cyst after anticoagulation therapy that caused progressive radiculopathy and cauda equina syndrome. The possible pathogenic mechanism, associated diseases, and treatment options are discussed.Various pathological processes can cause progressive cauda equina syndrome. However, there have been no reports of progressive cauda equina syndrome due to compression from an intraneural hemorrhagic cyst after anticoagulation therapy.A case of lumbar intradural intraneural hemorrhagic cyst with progressive cauda equina syndrome after anticoagulation therapy is presented.A 42-year-old-female patient complained at presentation of progressive bilateral lower extremity radiating pain, numbness, and urinary difficulty during the previous 2 months. Lumbar magnetic resonance imaging revealed an L1 cystic lesion with marked mass effect on the surrounding nerve roots. Complete drainage and excision of the lesion was performed, which resulted in excellent postoperative symptoms relief. Pathological examination revealed no definite neoplastic process except some nerve fibers with hemosiderin stain along the cyst wall. On the basis of a combination of intraoperative findings and pathology, an intradural intraneural hemorrhagic cyst that developed after systemic anticoagulation therapy was diagnosed.This is the first report of an intradural intraneural hemorrhagic cyst causing progressive cauda equina syndrome due to anticoagulation therapy. Surgical excision of the cyst is the definite treatment of choice.N/A.Keywords:
Cauda equina
Cauda Equina Syndrome
Hemosiderin
Urinary retention
Cauda equina syndrome (CES) is a serious neurological condition and the most common cause is a central disc herniation.Migration of a bullet down the spinal canal is uncommon.In this report, the authors present an unusual case of cauda equina syndrome caused by a migrated bullet in dural sac.The patient's cauda equina syndrome was related to possible compression of cauda equina resulting from both bone fragments in L1 level and bullet itself in S2 level.The patient's symptoms and neurological deficits resolved considerably after surgery.In our opinion, it is important to pay attention to diversity of injury when confronted with a gunshot wound.It is essential to perform early and sufficient surgical decompression of the cauda equina to provide a better postoperative neurological recovery.KeywoRdS: Cauda equina syndrome, Migrated bullet, Dural sac ÖZ Kauda equina sendromunun en sık sebebi santral disk herniasyonudur.Spinal kanal içinde bir merminin aşağı doğru yer değiştirmesi nadir olarak görülür.Olgumuz spinal kanal içinde aşağı doğru hareket eden merminin neden olduğu kauda equina sendromudur.Hastada gelişen kauda equina sendromunun lomber 1 seviyesindeki kemik parçacığına ve sakral 2 seviyesine doğru yer değiştiren merminin baskısına bağlı olarak gelişmiştir.Hastanın semptom ve bulguları cerrahi girişimden sonra önemli ölçüde düzelmiştir.Kanaatimizce ateşli silah yaralanmalarında hasarlanan bölge yanı sıra, olabilecek ek patolojilerinde gözöününe alınması gerekir.
Cauda Equina Syndrome
Cauda equina
Surgical decompression
Gunshot wound
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Suspected cauda equina syndrome is a common presentation in emergency departments, but most patients (≥70%) have no cauda equina compression on imaging. As neurologists become more involved with ‘front door’ neurology, referral rates of patients with these symptoms are increasing. A small proportion of patients without structural pathology have other neurological causes: we discuss the differential diagnosis and how to recognise these. New data on the clinical features of patients with ‘scan-negative’ cauda equina syndrome suggest that the symptoms are usually triggered by acute pain (with or without root impingement) causing changes in brain–bladder feedback in vulnerable individuals, exacerbated by medication and anxiety, and commonly presenting with features of functional neurological disorder.
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Abstract Cauda equina syndrome (CES) is a rare neurologic condition that is caused by compression of the cauda equina. Cauda equina consists of spinal nerves L2-L5, S1-S5 and the coccygeal nerve. The compression of these nerve roots can be caused mainly by lumbar disc herniation (45% of all causes). The diagnosis consists of two critical points: a) detailed history and physical examination and b) MRI or CT. The gold standard of the treatment of this syndrome is the surgical approach in combination with the timing of onset of symptoms. The surgery as an emergency situation is recommended in the fi rst 48 hours of onset of symptoms. Any delay in diagnosis and treatment leads to a poor prognosis of CES.
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Lumbar disc herniation
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6 cases of so-called redundant nerve roots of the cauda equina are reported, which brings the total number of cases described in literature to 27. The differential diagnosis of the myelographic picture of tortuous filling defects is discussed. The authors believe that the majority of these cases is caused by chronic compression of the nerve roots.
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Cauda Equina Syndrome
Nerve compression syndrome
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We report experience with patients presenting with a specific combination of symptoms: unilateral sciatica, unilateral sensibility loss in the dermatomes S1 to S5 (hemi-saddle) and subjective micturation problems secondary to ruptured lumbar disc. Because of its similarities with a cauda equina syndrome, this combination of symptoms was thought to be a unilateral cauda equina syndrome and it was called hemi-cauda equina syndrome. Consequently, it was treated as an emergency.Ten patients were evaluated. They compromised 2.3% of all patients undergoing lumbar discectomy.Outcome is good with only 10% persisting minor neurologic deficit (sensibility loss in dermatomes S3 to S5). With the exception of urinary retention or incontinence, duration of symptoms and signs does not seem to influence outcome. Comparing signs, symptoms and radiographic findings with those of a cauda equina syndrome which were recently and thoroughly studied, they were found to be more severe in cases of cauda equina syndrome. Especially, the good outcome, (apparently unrelated to the duration of symptoms in cases of hemi-cauda equina syndrome) contrasted with the treatment results of cauda equina syndrome.We defined the hemi-cauda equina syndrome from ruptured disc as a combination of unilateral leg pain, unilateral sensibility loss in dermatomes S1 to S5 and sphincter paralysis (proven urinary retention or incontinence). Motor deficit is not necessarily present. Emergency surgery is warranted. Patients presenting with micturation complaints other than urinary retention or incontinence do not suffer from a hemi-cauda equina syndrome.
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Cauda equina syndrome is a combination of symptoms and signs resulting from cauda equina compression. It requires a prompt diagnosis and emergency surgical referral. There is a large medicolegal burden surrounding the condition.
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Background: The clinical symptoms and signs of Cauda equina syndrome (CES) are non specific and poorly predictive of cauda equina compression on MRI. We aimed to establish whether a history of lumbar spine surgery predicts cauda equina compression on MRI in those presenting with suspected CES.Methods: A retrospective electronic record review was undertaken of 276 patients referred with clinically suspected CES who underwent a lumbosacral spine MRI. Those with a history of prior lumbar surgery were compared to those without. The likelihood of cauda equina compression was compared between the two groups.Results: About 78/276 (28%) patients with suspected CES had radiological compression of the cauda equina and went on to surgical decompression. A total of 54 (20%) patients had undergone prior lumbar surgery. Patients with a history of lumbar surgery were less likely to have cauda equina compression on MRI (χ2 – p = .035). Twenty six (9%) patients presented more than once with suspected CES. Patients with a history of lumbar surgery were more likely to re-present with suspected CES (χ2 – p = .002).Conclusions: Prior lumbar surgery was associated with a higher frequency of re-presentation with clinically suspected CES but a lower frequency of radiological cauda equina compression.
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Lumbosacral joint
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Cauda equina
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Lumbosacral joint
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The human spine is a complex and robust structure. Injury to the spine may contribute to limitations in activities of daily living. In the lumbar and sacral regions, the nerve roots continue as the cauda equina. These nerves communicate with the lower limbs and pelvic organs by sending and receiving messages. Cauda equina syndrome is a rare but potentially life-threatening illness caused by spinal canal compression of the cauda equina. Cauda equina syndrome occurs when there is dysfunction of multiple lumbar and sacral nerve roots of the cauda equina. Here is a case of a 25-year-old male, who visited the hospital with complaints of low back pain, weakness in the bilateral lower limb and urinary incontinence. He had a history of a fracture at lumbar vertebrae 10 years ago for which internal fixation was done. The patient was diagnosed with cauda equina syndrome post investigations and underwent implant removal surgery. He was further referred to the physiotherapy department for management of the same.
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Urinary retention
Back Pain
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