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PubMed1983

Paraganglioma of cauda equina. A report of a case and review of the literature.

A case of a cauda equina paraganglioma in a 13-year-old boy is described. A review of literature revealed six similar reported cases. All were intradural extramedullarly tumors located in the cauda equina-filum terminale region. In all, the presenting and dominant symptom was low back pain, while neurologic deficit was mild or absent. Excessive CSF protein levels appeared to be a characteristic feature of the disease. Histologically, the tumor displayed the typical "Zellballen" pattern, however mild nuclear pleomorphism and some mitotic figures were noted. As it is impossible to predict the biological behaviour of paragangliomas from the histologic appearance, complete surgical resection with close follow-up is indicated in such cases.

Adolescent↗
PubMed2002

Significance of low compliance bladder in cauda equina injury.

STUDY DESIGN: Prospective investigation using serial urodynamic studies. OBJECTIVE: To evaluate type of neurogenic bladder and to observe changes of autonomous detrusor contraction (ADC) after the normalization of the compliance and capacity of the bladder in cauda equina injury. SETTING: Spinal Cord Injury Unit, Yonsei Rehabilitation Hospital, Seoul, Korea. METHODS: Urodynamic studies were performed in 50 patients with complete cauda equina injury from trauma with an infusion ratio of 30 ml/min. Findings of urodynamic studies and clinical features of patients with low compliance were compared with those of the normal compliant patients. Fourteen patients with low compliance received oral administration of oxybutynin and propiverine and intravesical instillation of oxybutynin to increase the compliance and capacity of the bladder, and follow-up urodynamic studies to monitor the change were undertaken. RESULTS: Bladder compliance was decreased in 14 (28%) patients and normal in 36 (72%) patients. There was a significantly long time interval between the onset of injury and the initiation of rehabilitative treatment in the neurogenic bladder group with low compliance when compared to those of the normal compliance group (P < 0.05). Clean intermittent catheterization was used as the voiding method, significantly less than the normal compliance group (P < 0.05). ADC was observed in six out of fourteen patients with low compliance neurogenic bladder, but none in the normal compliance group. Upon the completion of conservative treatment, ADC disappeared in four patients whose compliance and capacity of the bladder were normalized on follow-up urodynamic studies. CONCLUSION: ADC was only observed in the low compliant bladder and as ADC disappeared when compliance and capacity of the bladder was normalized; low compliance appeared to be the main cause of ADC. In addition, this study supports that the maintenance of compliance of the bladder may be the most important factor in the management of neurogenic bladder.

Administration, Intravesical↗
PubMed2003

Neurosarcoidosis of the conus medullaris and cauda equina.

An uncommon case of neurosarcoidosis of the conus medullaris and cauda equina is described in a 24-year-old man with a 4-year history of urological symptoms and rash. Chest X-ray and biopsy confirmed sarcoidosis and MRI diagnosed conus medullaris involvement.

Adult↗
PubMed1981

Neurofibrosarcoma of the cauda equina. Case report.

A case of a malignant neurofibroma of the cauda equina is described. Its location seems to be rare. An extensive surgical resection including the adjacent neural tissue and the enveloping dural sac was carried out, followed by radiotherapy.

Adult↗
PubMed2005

Posterior epidural migration of sequestered lumbar disc fragment causing cauda equina syndrome.

Posterior epidural migration of free disc fragments is rare, and posterior migration of the free fragments causing cauda equina syndrome is exceptionally rare. This report describes a 53-year-old man with disc fragment extrusion at the levels of L3-4 and a 54-year-old man with disc fragment extrusion at L5-S1 intervertebral space. The patients responded well to the operative therapy with complete relief of the symptoms. The pathological examination confirmed that the specimen was a degenerated intervertebral disc. Early surgery should be the first choice of therapy in patients with large posteriorly migrated sequestered disc fragments, to prevent severe neurological deficits such as cauda equina and conus medullaris syndromes.

Humans↗
PubMed1996

Cauda equina paraganglioma with subsequent intracranial and intraspinal metastases.

A case of cauda equina paraganglioma is described; subsequent intracranial and intraspinal metastases occurred after partial resection and adjunctive radiotherapy. Cerebrospinal fluid dissemination is a rare complication of spinal paragangliomas. Factors predictive of this unusual biological behaviour are discussed.

Biomarkers, Tumor↗
PubMed1995

[Lesions of the conus medullaris and the cauda equina caused by cytomegalovirus in HIV infection. 7 cases].

OBJECTIVES: Neurologic infections caused by cytomegalovirus are common in patients with acquired immunodeficiency syndrome (AIDS). The prognosis is particularly severe when the infection is localized in the conus medullaris and/or the cauda equina. METHODS: Among the 861 patients with AIDS treated in our unit from 1991 to 1993, 7 cases involving cytomegalovirus infection of the conus medullaris and/or the cauda equina were studied retrospectively. RESULTS OF THE CASE REPORTS: Clinical manifestations were nearly always the same: low back pain, motor deficiency in the lower limbs progressing to flaccid paraplegia and sphincter failure. The cerebrospinal fluid contained a high cell count with unaltered polynuclears and increased protein levels. In 6/7 patients virus cultures and search for the viral genome in the cerebrospinal fluid were positive. The clinical course was favourable in 6 patients after 3 weeks treatment with ganciclovir and/or foscarnet. Virology tests became negative in three-fourths of the patients. Nevertheless, relapse occurred after 4.2 weeks despite long-term therapy. CONCLUSION: The severe clinical course of this disease and the gravity of constantly fatal relapse requires highly adapted treatment and overall health care.

AIDS-Related Opportunistic Infections↗
PubMed2000

Acute cauda equina syndrome caused by a gas-containing prolapsed intervertebral disk.

Gas production as a part of disk degeneration can occur, but it rarely causes clinical nerve compression syndromes. A rare case of gaseous degeneration in a prolapsed lumbar intervertebral disk causing acute cauda equina syndrome is described. Radiologic features and intraoperative findings are reported. A 78-year-old woman with severe lumbar canal stenosis had acute cauda equina syndrome. Magnetic resonance imaging revealed a large disk protrusion, and she underwent an urgent operation for this. Surgery confirmed the severe lumbar canal stenosis, but the disk prolapse contained gas that had caused the nerve compression.

Aged↗
PubMedDate not supplied

Mesenchymal chondrosarcoma of the cauda equina.

Primary central nervous system mesenchymal chondrosarcomas are extremely rare tumors composed of primitive mesenchymal cells punctuated by islands of cartilage in various stages of differentiation. Although there are isolated reports of tumors arising in the spinal dura, to our knowledge extraskeletal mesenchymal chondrosarcoma localized to the cauda equina has not been reported in the literature. We present an unusual case of a mesenchymal chondrosarcoma involving the nerve roots of the cauda equina. The clinical, pathological and neuroimaging features are reviewed and discussed.

Adult↗
PubMed2005

Ganglioneuromatous paraganglioma of the cauda equina--a pathological case study.

This study presents a rare case of compound paraganglioma/ganglioneuroma with comprehensive immunohistochemical studies that reveal strong cytokeratin expression in all components. A 74-year-old woman presented with a mass lesion of the cauda equina. The 1.8-cm tumor showed 3 histomorphologically and immunohistochemically distinct components: typical paragangliomatous neuroendocrine areas, mature ganglion cell-like neuronal areas, and a "neuromatous" proliferation of Schwann cells with admixed axons. As often seen in cauda equina paragangliomas, the neuroendocrine cells were cytokeratin-positive. In addition, immunoreactivity for cytokeratins was also observed in the neurons and axons. This tumor illustrates the broad spectrum of divergent differentiation that can be seen in cells of sympathoadrenal lineage.

Aged↗
PubMed1988

Tumors of the cauda equina: the importance of an early diagnosis.

The natural history of cauda equina tumors was studied in 13 patients. Pain was the most prominent clinical manifestation. Neurological dysfunction mainly consisted of sensory disturbances. The pre-operative course was in 62% three years or longer. A relation was found between the histology of the tumor and the delay of diagnosis: ependymomas were discovered much later than schwannomas. Other histological types of tumors were meningioma, sarcoma and metastasis of a medulloblastoma. The effect of treatment, in nine cases only surgical, was excellent in seven of the 13 patients. The prognosis was determined by histology and length of pre-operative period.

Adolescent↗
PubMed1991

The anatomy of the cauda equina on CT scans and MRI.

The nerve roots of the cauda equina may be visualised by contrast-enhanced CT scans and by surface-coil MRI. We have identified the pattern of anatomy from L2-L3 to L5-S1 in 10 human cadaver specimens and correlated this with anatomical dissections. Individual roots are slightly more distinct on contrast-enhanced CT than on surface-coil MRI. There is a crescentic oblique pattern of nerve roots at the lower lumbar levels which is still apparent in the more crowded proximal sections. In all cases, the axial images correlated precisely with the dissections. Current imaging modalities can help the clinical understanding and management of abnormalities in this region of the spine.

Adult↗
PubMed1998

[An experimental observation of repair after transection of cauda equina fibers in cat].

OBJECTIVE: To explore the regeneration characteristics after cauda equina transection. METHODS: Fibrin glue was chosen to repair transected left L6,7 roots in cat, and right roots in situ of the transected ends were served as the control. The characteristics of regeneration were observed by immunohistocytochemistry and morphometric analysis. RESULTS: Regeneration was found not only in site of anastomosis, but also in corresponding spinal segments and DRGs. Sensory and motor evoked potentials (SEP and MEP) performed before and after transection and before taking specimen revealed the course of functional recovery on severed and regenerated nerve roots. The regeneration of moter roots was better than that of sensory roots, and they were mainly blocked at the site of central-peripheral transition zone. CONCLUSIONS: The method of adhesion by fibrin glue can replace traditional suture, and it is superior to suture.

Animals↗
PubMed1983

Neurourologic findings in conus medullaris and cauda equina injury.

Fifty-seven patients with documented conus medullaris and cauda equina injury underwent neurourologic evaluation consisting of cystometrography (CMG), perineal floor electromyography (EMG), and bethanechol chloride supersensitivity testing (BST). The bulbocavernosus reflex was normal in only 16% of the patients, and perineal sensation and muscle stretch reflexes were absent or significantly diminished in 77%. The predominant CMG finding was detrusor areflexia (93%). Neuropathic EMG changes were noted in 67% and a positive BST response in 95% of the cases. Statistical analysis showed significant correlations between (1) a compromised bulbocavernosus reflex and perineal floor neuropathy (.01 less than P less than .05) and (2) sex of the patient and incidence of urinary incontinence among subjects with perineal floor neuropathy (P less than .01). The major neurourologic features in these patients (1) An absent or substantially diminished bulbocavernosus reflex, (2) detrusor areflexia on CMG, (3) neuropathic perineal EMG changes, and (4) a positive BST response.

Adolescent↗
PubMedDate not supplied

Arteries and veins of the lumbar nerve roots and cauda equina.

An abundant vascular system supplies the nerve roots, within the cauda equina, in the spinal canal and in the nerve root tunnels. The arterial supply of nervous tissue, as noted by previous observers, is "just adequate for its minimal needs." The veins of the area are classified into 3 groups, those of the spinal canal within the extradural space, those of the nerve roots themselves (radicular veins) and those which drain the bony skeleton. These thin-walled venous channels are a source of serious bleeding both at operation and in the postoperative period. Elsewhere in this symposium, emphasis has been placed on the way in which spinal stenosis and pressure on nerves cause the complex group of symptoms. Pressure on arteries, veins and capillaries can impair nerve conduction, with changes in sensation and loss of motor power in one or both limbs. If the pressure is prolonged, irreversible changes take place in the substance of the nerve roots. Recovery of sensation and of motor power following adequate surgical decompression will then be incomplete.

Arteries↗