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PubMed2006

Monoaminergic control of cauda-equina-evoked locomotion in the neonatal mouse spinal cord.

Monoaminergic projections are among the first supraspinal inputs to innervate spinal networks. Little is known regarding the role of monoamines in modulating ongoing locomotor patterns evoked by endogenous release of neurotransmitter. Here we activate a locomotor-like rhythm by electrical stimulation of afferents and then test the modulatory effects of monoamines on the frequency, pattern, and quality of the rhythm. Stimulation of the cauda equina induced a rhythm consisting of left-right and ipsilateral alternation indicative of locomotor-like activity. First, we examined the effects of noradrenaline (NA), serotonin (5-HT), or dopamine (DA) at dose levels that did not elicit locomotor activity. Bath application of NA and DA resulted in a depression of the cauda-equina-evoked rhythm. Conversely, bath-applied 5-HT increased both the amplitude and cycle period of the evoked rhythm, an effect that was mimicked by the addition of 5-HT(2) agonists to the bath. Application of 5-HT(7) agonists disrupted the evoked rhythmic behavior. Next, we examined the effects of NA alpha(1) and alpha(2) agonists and found that the suppressive effects of NA on the rhythm could be reproduced by adding the alpha(2) agonist, clonidine, to the bath. In contrast, bath applying the alpha(1) agonist, phenylephrine, increased the amplitude and duration of the cycle period. Finally, the suppressive effects of DA were not replicated by the administration of D(1), D(2), or D(3) agonists although application of NA alpha(2) antagonists reversed the effects of DA. Application of D(1) agonists, increased the amplitude of the bursts but did not affect the cycle period. Our results indicate that monoamines can control the expression, pattern, and timing of cauda-equina-evoked locomotor patterns in developing mice.

Adrenergic alpha-2 Receptor Agonists↗
PubMed1992

Clinical features of intradural neurinomas in the cauda equina and around the conus medullaris.

In this contribution the clinical features of eleven patients suffering from a neurinoma in the cauda equina and around the conus medullaris are analysed. Because of the relative mobility of the roots and the wide space in the spinal canal, tumours arising in the cauda equina or around the conus medullaris can become larger than any other spinal tumours. Lumbago was the predominant symptom as the initial complaint. Nocturnal pain relieved by walking was noticed in one patient. Two cases showed spontaneous remission and relapse. Multiple tumours were found in 6 cases (55%). Macroscopic cyst formation was found in 5 cases (45%). Among the eleven patients, total removal of the tumour, including the involved root, was performed in ten. The numbers of the resected nerve roots were one root in 6 cases, two roots in 2, and three roots in 2. Only one patient showed postoperative slight weakness of the leg.

Adult↗
PubMed1990

Report of a cavernoma of the cauda equina and review of the literature.

Subdural intramedullary and extramedullary cavernous angiomas are rare vascular malformations. A case of cavernoma of the cauda equina affecting a 46-year-old man is reported. He presented with low back and sciatic pain. This is the fourth case of cavernoma of the cauda equina in the literature. The available literature on intramedullary (28 cases) and extramedullary (9 cases) cavernomas is reviewed.

Cauda Equina↗
PubMedDate not supplied

Paraganglioma of the cauda equina: an ultrastructural and immunohistochemical study of two cases.

The ultrastructural and immunohistochemical features of 2 paragangliomas arising in the cauda equina are described. In both cases the tumor cells were arranged in small nests or cords and contained characteristic neurosecretory granules, lamellar stacks of rough endoplasmic reticulum (RER), and some well-developed Golgi apparatuses in their cytoplasm. The cells varied in electron density; the darker cells, occasionally resembling sustentacular cells, were probably dehydrated light cells because they contained a few neurosecretory granules. Sustentacular cells were difficult to identify by electron microscopy, but irregularly distributed S-100 protein and glial fibrillary acidic protein (GFAP) were found in these cells by immunostaining. Many tumor cells contained abundant neurofilaments. Curiously, a few cytokeratin-positive cells were found in 1 case. On microscopic examination, a small area of ganglioneuroma was found associated with the paraganglioma in 1 case. Ganglionic differentiation was concluded to be frequent in paragangliomas of the cauda equina region as in duodenal paragangliomas.

Adult↗
PubMed1996

Cauda equina metastasis from ovarian malignancy.

SUMMARY: A case of cauda equina metastasis from ovarian serous papillary adenocarcinoma in a 51-year-old patient is reported. The clinical significance and different hypotheses on the metastatic route to the spine are discussed.

Cauda Equina↗
PubMed2004

Cauda equina syndrome in lumbar spinal stenosis: case report and incidence in Jutland, Denmark.

BACKGROUND: Cauda equina syndrome in spinal stenosis is a rare complication. During a 5-year period (1996-2000), 340 cases of spinal stenosis were diagnosed in the County of South Jutland, Denmark. The annual incidence of spinal stenosis was 272 per million inhabitants. During that period, only one patient with acute cauda equina syndrome in spinal stenosis was diagnosed: that is, the patient described herein. METHODS AND RESULTS: A 74-year-old woman appeared with urinary retention and fecal incontinence for the previous 24 hours. Computed tomography scan showed spinal stenosis from L2 to L4. She underwent an urgent operation and recovered within 5 days from her anal sphincter paresis and within 5 weeks from her bladder paresis.

Aged↗
PubMed2006

Cauda equina syndrome presentation of sacral insufficiency fractures.

INTRODUCTION: Sacral insufficiency fractures are a well recognised cause for low back, buttock and groin pain in the elderly. However, over a 4 year period, four patients have presented with symptoms of cauda equina syndrome, who were found on investigation to have acute sacral insufficiency fracture without any other aetiological spinal abnormality. PATIENTS AND METHOD: Four patients who presented to the spinal surgeons of our institution with symptoms of cauda equina syndrome were referred for spinal MR. Sagittal and axial T1 and T2 weighted turbo spin echo sequences of the lower thoracic and lumbar spine were performed on all patients. Subsequent studies included MR of the sacrum supplemented where appropriate by CT and technetium MDP bone scintigraphy. RESULTS: No evidence of a compressive lesion of the lower thoracic or lumbar spine was present in any of the four patients. Dedicated MR examination of the sacrum in these patients revealed unilateral acute insufficiency fractures involving zone 1 from S1 to S3 extending from the sacro-iliac joint to the lateral margin of the sacral foramen. There was no evidence of compression of the sacral nerve roots. The possible mechanism for the symptomatic presentation is discussed. CONCLUSION: Sacral insufficiency fractures should be excluded in elderly or osteoporotic patients presenting with cauda equina syndrome who have no evidence of compression in the thoraco-lumbar MR studies.

Aged↗
PubMed1986

Cauda equina syndrome and lumbar disc herniation.

In a retrospective chart review of the cases of thirty-one patients with cauda equina syndrome secondary to a central disc lesion, we identified two modes of presentation. The first was an acute mode (ten patients) in which there were abrupt, more severe symptoms and signs and a slightly poorer prognosis after decompression, especially for the return of bladder function. The second mode of presentation (twenty-one patients) was a slower onset, characterized by prior symptoms for varying time-intervals before the more gradual onset of the cauda equina syndrome. All patients had urinary retention preoperatively. Bladder function was the most seriously affected function preoperatively and remained so postoperatively. The prognosis for return of motor function was good, since twenty-seven of the thirty patients who were operated on regained normal motor function. Preoperatively all patients had sciatica, which was bilateral in fourteen and unilateral in seventeen. The average time to surgical decompression after the patient was seen ranged from 1.1 days for the more acute lesions to 3.3 days for the second group. There was no correlation of these times with return of function. Therefore, even though early surgery is recommended, decompression does not have to be performed in less than six hours if recovery is to occur, as has been suggested in the past.

Adult↗
PubMed2004

A case with cauda equina syndrome due to bacterial meningitis of anterior sacral meningocele.

STUDY DESIGN: A case of a patient with anterior sacral meningocele that was misdiagnosed as perianal abscess is presented. After the transrectal aspiration, the patient developed meningitis and cauda equina syndrome. OBJECTIVE: To report a rare case of anterior sacral meningocele in which primary presentation was mimicking perianal abscess. SUMMARY AND BACKGROUND DATA: Anterior sacral meningocele is a rare example of spinal dysraphism. It is created by a herniation of a dural sac through a defect in the sacral wall. It is usually asymptomatic until later decades. Most of the presenting symptoms are related to the pelvic organs. In the management of anterior sacral meningocele, surgical treatment is necessary. METHODS: The reported case is that of a 35-year-old female with cauda equina syndrome due to bacterial meningitis of the anterior sacral meningocele. At the beginning, she presented signs and symptoms resembling perianal abscess. She was misdiagnosed as anorectal abscess according to the computed tomography findings. The patient then underwent transrectal aspiration. Following the aspiration, meningitis and cauda equina syndrome were developed. Meningitis was treated with the appropriate antibiotics, and the patient underwent rehabilitation for paraplegia and bladder and bowel incontinence. RESULTS: Following the rehabilitation program, the patient has recovered completely within 8 months. CONCLUSION: This case represents a rare example of anterior sacral meningocele in which the patient was misdiagnosed as perianal abscess. Meningitis either iatrogenic or spontaneous may occur during the course of anterior sacral meningocele. Once it has occurred, it may result in severe morbidity and mortality. However, our case had been treated effectively, and she had regained her health with rehabilitation program.

Abscess↗
PubMed1981

Redundant nerve roots of the cauda equina.

Four cases of redundant nerve roots of the cauda equina are reported, and the pertinent literature is reviewed. This disorder mainly affects males. The clinical history ranges from months to decades. The illness often starts with low back pain or sciatica, or both. Motor and sensory impairment of the legs dominate the further course of the disease. Serpentine filling defects in the column of contrast are a characteristic (but inconstant) feature on myelograms. Abatement of signs and symptoms occurs following adequate decompression of the redundant roots.

Adult↗
PubMed2004

Two cases of nondura-based clear cell meningioma of the cauda equina.

Clear cell meningioma is a rare disorder. We report two cases of nondura-based clear cell meningioma of the cauda equina, one in a 24-year-old male and the other in a 19-year-old female. Both patients had complained of numbness and spontaneous pain in the lower back and limbs for several months. Magnetic resonance imaging and computed tomography scanning revealed an intradural tumor in the cauda equina in each case. At surgery, a neurilemoma was suspected, because each of the tumors had displaced nerve roots and had attached to one of the nerve roots without any adherence to the dura. Light microscopy revealed that both tumors were well-demarcated with a thin capsule and consisted mainly of clear, glycogen-rich, polygonal cells with vague whorl formations, and of copious deposits of hyalinized blocky collagen in the stroma and perivascular areas. The neoplastic cells were immunopositive for vimentin and epithelial membrane antigen, but immunonegative for S-100 protein and chromogranin A. Positive nuclei for MIB-1 were very few in both cases, and PCNA-labeling indices were 12.1% and 24.7%, respectively. No local recurrence has been seen for 61 months and for 52 months, respectively.

Adult↗
PubMed2002

Oncocytic paraganglioma of the cauda equina in a child. Case report and review of the literature.

The authors report a case of oncocytic paraganglioma of the cauda equina in a 12-year-old girl who presented with lower back and leg pain on the right side of 6 months' duration. Magnetic resonance imaging revealed an ellipsoidal, intradural, extramedullary mass causing cord compression at the level of L1. Total laminectomy was performed on T12 and L1, and the tumor was excised completely without difficulty despite adherence of the tumor to the spinal cord. Postoperatively, the leg pain and motor weakness were much improved. The use of electron microscopy, and the immunohistochemical demonstration of synaptophysin in this tumor, allowed a confident diagnosis of an oncocytic paraganglioma to be made. To the authors' knowledge, this patient represents the first definite case of an oncocytic paraganglioma of the cauda equina in a child.

Cauda Equina↗
PubMed1991

Cauda equina syndrome after continuous spinal anesthesia.

Four cases of cauda equina syndrome occurring after continuous spinal anesthesia are reported. In all four cases, there was evidence of a focal sensory block and, to achieve adequate analgesia, a dose of local anesthetic was given that was greater than that usually administered with a single-injection technique. We postulate that the combination of maldistribution and a relatively high dose of local anesthetic resulted in neurotoxic injury. Suggestions that may reduce the potential for neurotoxicity are discussed. Use of a lower concentration and a "ceiling" or maximum dose of local anesthetic to establish the block should be considered. If maldistribution of local anesthetic is suspected (as indicated by a focal sensory block), the use of maneuvers to increase the spread of local anesthetic is recommended. If such maneuvers prove unsuccessful, the technique should be abandoned.

Aged↗
PubMed1990

Paraganglioma of the cauda equina. Report of three cases.

The authors report the clinical, radiological, and pathological findings in three cases of paraganglioma of the cauda equina. In one case, magnetic resonance imaging and neurochemical study results are described. No specific identifying features were encountered either clinically or radiologically that were helpful in making a distinction between this and other more common tumors at this site such as ependymoma or neurofibroma. At surgery, these neoplasms were well-circumscribed red fleshy tumors. Histological examination of one paraganglioma showed a superficial resemblance to ependymoma, and this may be particularly true on initial assessment by frozen section or smear. The use of electron microscopy and immunohistochemical demonstration of synaptophysin in these tumors allowed a confident diagnosis to be made. Neurochemical assessment in one case showed very high levels of serotonin and a turnover of dopamine similar to that of human cerebral cortex. Paraganglioma of the cauda equina is an uncommon tumor with just over 50 cases reported in the world literature. The clinical course of these tumors is benign and they should be completely removed at surgery to prevent later recurrence.

Adult↗
PubMed2004

Role of motor evoked potentials in diagnosis of cauda equina and lumbosacral cord lesions.

OBJECTIVE: To determine the diagnostic value of motor evoked potentials (MEPs) in the diagnosis of lumbosacral cord disorders. METHODS: MEPs in 37 patients with sensory and motor deficits in the lower limbs were studied. MRI demonstrated spinal cord involvement in 10 patients and cauda equina lesions in 27 patients. A double determination of central motor conduction time (CMCT), calculated as the difference between the latencies of responses evoked by cortical and paravertebral magnetic stimulation and as the difference between the latency of cortical MEP and the total peripheral conduction time calculated from the F-wave latency, enabled discrimination between a delay along the proximal root and a delay along the corticospinal tract. An abnormality of the CMCT calculated with both techniques is indicative of central motor pathway damage, whereas an abnormality of the CMCT calculated from the latency of responses evoked by paravertebral magnetic stimulation associated with a normal CMCT calculated from the F-wave latency suggests a cauda equina lesion. RESULTS: Neurophysiologic findings strongly correlated with the lesion site documented by MRI (cauda equina or lumbosacral cord). All patients with MR evidence of cord involvement had an abnormality of CMCT calculated with both methods, suggesting a lesion of central motor pathways. Clinical examination often failed to document a spinal cord lesion, suggesting pure peripheral involvement in 5 of the 10 patients with MR evidence of cord lesion. CONCLUSION: Motor evoked potential recording is an accurate and easily applicable test for the diagnosis of lumbosacral spinal cord lesions.

Aged↗
PubMed1984

Redundant nerve roots of the cauda equina.

The authors have critically reviewed 8 cases which have come under their observation of a lumbosciatic syndrome due to redundant nerve roots of the cauda equina. Some of the clinical and myeloradiculographic features appear to be characteristic of this rare syndrome. Surgical intervention by decompressing the nerve roots of the cauda equina offers a very favourable prognosis.

Acute Disease↗