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At least 415 records · Page 23Linked to original sources
PubMed2004

Segmental anomaly leading to wrong level disc surgery in cauda equina syndrome.

STUDY DESIGN: A case report of unrecognized lumbarization of the S-1 vertebral body leading to wrong-level disc surgery in a patient with acute cauda equina syndrome secondary to a large disc extrusion at the L4-L5 interspace. Laminectomy and excision were initially performed at the level of L5-L6. OBJECTIVES: To review the importance of detection of lumbosacral transitional vertebrae when performing interventional procedures in the lumbar spine. SUMMARY OF BACKGROUND DATA: Lumbosacraljunction transitional vertebrae have been well documented. Likewise, surgery at the wrong intervertebral level has been reported as a reason for failure of lumbar spine surgery. There is also brief mention in the literature of lumbar disc surgery performed at incorrect levels in part secondary to junctional anomalies. However, there is no recorded case of wrong-level disc surgery in acute cauda equina syndrome occurring as a result of an unrecognized lumbarization or sacralization of transitional vertebrae. METHODS: A case report of wrong level disc surgery in a patient with lumbarization of the S-1 sacrum is presented. The literature, clinical course, and imaging studies are reviewed and techniques for detection of transitional vertebral bodies are discussed. CONCLUSION: The presence an undetected congenital spinal anomaly, lumbarization of the S-1 vertebral body, resulted in mistaken intraoperative identification of the L4-5 space in this patient resulted in decompression at the wrong level requiring a second surgery. Lumbosacral transitional vertebrae can often be overlooked on plain radiographs and magnetic resonance imaging of the lumbar spine. It is essential to be alert to the possibility of transitional vertebrae when evaluating these imaging studies, particularly in the operative treatment disc disease.

Journal Article↗
PubMed1985

Hemangioblastoma of the cauda equina.

A very rare hemangioblastoma of the filum terminale with sciatic pain and partial cauda syndrome in a 36-year-old man is presented. The difference between solitary hemangioblastoma, hemangioblastomatosis and von Hippel-Lindau disease is stressed. The literature is reviewed and the diagnosis of cauda equina neoplasms is discussed. Even nowadays often the final diagnosis is made late and only after operation and microscopical tissue examination.

Adult↗
PubMed1997

Malignant cauda equina paraganglioma in a cat.

An 11-year-old spayed female domestic long-haired cat presented for surgical removal of a slowly growing and deeply invasive 2.5 x 3.5-cm mass cranial to the base of the tail. Light microscopic examination of surgical biopsy specimens revealed an encapsulated mass composed of packets of polygonal cells of various sizes separated by a delicate fibrovascular stroma. Gömöri's reticulum stain revealed a characteristic endocrine or "Zellballen" pattern. Tumor cells contained diffuse positive reactivity to synaptophysin and neuron-specific enolase, reactions consistent with a neuroendocrine neoplasm. S-100 protein-positive cells reminiscent of sustentacular (support) cells occurred singly or in small clusters within tumor packets. At postmortem examination 3 months later, a 9- x 5- x 4-cm multinodular raised tan mass involving the caudal pelvis, sacrum, and tail-head regions was found. The base of this neoplastic mass originated within the cauda equina region and involved approximately five caudal nerve roots. Numerous 1-3-mm metastatic nodules were identified disseminated throughout the pulmonary parenchyma. The tumor was diagnosed as a malignant paraganglioma of the cauda equina region with pulmonary metastasis.

Animals↗
PubMed2004

Spontaneous hemorrhage of a spinal ependymoma: a rare cause of acute cauda equina syndrome: a case report.

STUDY DESIGN: An interesting case of spontaneous bleeding from an ependymoma of the filum terminale is presented. OBJECTIVES: To document a rare case of rapid neurologic deterioration as a consequence of spinal tumoral hemorrhage and to highlight important issues regarding tumor histologic subtype and the impact of anticoagulation that have emerged from an illuminating review of the literature. SUMMARY OF BACKGROUND DATA: To our knowledge, there have been only 8 reported cases of hemorrhage from an ependymoma of the filum terminale or conus medullaris causing acute cauda equina syndrome. Bleeding is described in the pathology texts as being a consequence of the vascular architecture of the myxopapillary subtype and so postulated to be more common in this group. Anticoagulation is recognized to increase the frequency of tumoral bleeding, but no studies report its effect of severity of clinical presentation. METHODS: We report the case of a 57-year-old woman who developed nontraumatic acute cauda equina syndrome, including sphincter compromise. She underwent a lumbosacral laminectomy for evacuation of a hematoma, at which stage a filum terminale ependymoma was excised. Histopathologic analysis demonstrated it to be of a nonmyxopapillary subtype. RESULTS: The patient demonstrated gradual improvement of the neurologic deficit. At 12-month follow-up, her saddle area sensory deficit has resolved, her right lower limb is much stronger allowing her to walk long distances, and she is successfully performing intermittent self-catheterization of her bladder. CONCLUSIONS: The possibility of an underlying tumor should always be borne in mind so that adequate preoperative planning can be undertaken. The presence of the myxopapillary subtype should not prevent a clinician from excluding other reasons for hemorrhage, and counseling when reinstituting anticoagulation must include warning against a worse prognosis from any future hemorrhage.

Anticoagulants↗
PubMed1982

Mobile neurinoma of the cauda equina. Case report.

A mobile neurinoma arising from a redundant nerve root of the cauda equina is reported. The abnormal length of the nerve root allowed the neoplasm to move in the cranio-caudal direction along two segments of the spine.

Cauda Equina↗
PubMed1977

A metastasizing ependymoma of the cauda equina. Case report.

A case is described in which a metastatic ependymoma of the cauda equina recurred after prolonged remission. Similarities to five previously reported cases are discussed, with emphasis on the mode of metastasis. Factors most closely associated with distant metastases include early onset, numerous local operations, long survival, and massive local recurrence at the time of distant metastases.

Adult↗
PubMed1995

Cauda equina syndrome in ankylosing spondylitis: a case report and review of the literature.

The cauda equina syndrome (CES) is an infrequently recognised and poorly understood complication of ankylosing spondylitis (AS). We report a case of CES with enlarged caudal sac and multiple posterior arachnoid diverticula eroding the laminae and spinous processes of the lumbosacral vertebrae in a patient with long-standing AS. The diagnosis was established using computerised tomography (CT) and magnetic resonance imaging (MRI).

Cauda Equina↗
PubMed2001

Posterior epidural migration of a lumbar disc fragment causing cauda equina syndrome: case report and review of the relevant literature.

Posterior epidural migration (PEM) of free disc fragments is rare, and reported PEM patients usually presented with radicular signs. An uncommon case involving a patient with cauda equina syndrome due to PEM of a lumbar disc fragment is reported with a review of the literature. The patient described in this report presented with an acute cauda equina syndrome resulting from disc fragment migration at the L3-L4 level that occurred after traction therapy for his lower back pain. The radiological characteristics of the disc fragment were the posterior epidural location and the ring enhancement. A fenestration was performed and histologically confirmed sequestered disc material was removed. An early postoperative examination revealed that motor, sensory, urological, and sexual functions had been recovered. At late follow-up, the patient was doing well after 18 months. Sequestered disc fragments may occasionally migrate to the posterior epidural space of the dural sac. Definite diagnosis of posteriorly located disc fragments is difficult because the radiological images of disc fragments may mimic those of other more common posterior epidural lesions.

Diagnosis, Differential↗
PubMed1996

Amyloidosis-related cauda equina compression in long-term hemodialysis patients. Three case reports.

STUDY DESIGN: These case reports illustrate the neurologic manifestations due to beta 2 microglobulin amyloid deposition at the lumbar spine level in long-term hemodialysis patients. OBJECTIVE: Radiologic investigations suggested the amyloid origin of extradural soft tissue deposition, which was confirmed by histologic examination after surgical excision. SUMMARY OF BACKGROUND DATA: Although cervical myelopathy is a recently recognized complication of long-term dialysis-related beta 2 microglobulin amyloidosis, neurologic manifestations due to amyloid deposition at the lumbar spine level have rarely been reported. METHODS: Three case reports of cauda equina compression in long-term hemodialysis patients are presented. Follow-up radiography, computed tomography, and magnetic resonance imaging were performed and patients underwent surgical decompression of the thecal sac. RESULTS: In two patients, the compression resulted from the development of a destructive spondylarthropathy, and from the infiltration of extradural spaces and ligaments by an abnormal soft tissue. The third patient had lumbar spinal stenosis due to multiple disc protrusion and to hypertrophy of facet joints and ligamentum flavum. Multilevel laminectomies enabled excision of an abnormal fibrous tissue responsible for the thecal sac compression. Histologic examination of the excised fibrous tissues disclosed amyloid deposits in intervertebral discs, apophysial joints, and ligaments. CONCLUSIONS: In long-term hemodialysis patients, cauda equina compression may develop as the consequence of beta 2 microglobulin amyloid deposition in lumbar intervertebral discs, facet joints, and ligaments. Magnetic resonance imaging is well suited to show the extent of the compression and supports the argument for the amyloid origin of extradural soft tissue.

Adult↗
PubMed1987

Cavernous angioma of the cauda equina producing subarachnoid hemorrhage. Case report.

A case of a cavernous angioma of the cauda equina is presented. The patient was a 28-year-old man who experienced sudden low-back pain and headache without neurological symptoms. Lumbar puncture revealed subarachnoid hemorrhage. He had suffered a similar episode 3 years previously. Selective spinal angiography did not demonstrate any abnormal vascularity. Metrizamide myelography and magnetic resonance imaging were useful in demonstrating the presence of a tumor. Laminectomy at L1-3 and total removal of the tumor were performed without neurological deficit.

Adult↗
PubMed1979

Neuritis of the cauda equina, a chronic idiopathic polyradiculoneuritis in the horse.

Four cases of neuritis of the cauda equina (NCE) were studied by light and electron microscopy. Examination of sacral intradural rootlets revealed inflammatory cell infiltrates and an array of myelinated fiber changes which included myelin stripping by invading mononuclear cells and macrophages, as well as splitting and vesiculation of myelin lamellae without obvious participation by leukocytes. More distally in the extradural roots, there was marked granulomatous inflammation, and demyelinative changes were overshadowed by widespread evidence of irreversible axon damage. In all cases, unusual crystalline inclusions appeared in the endoneurium and sheaths of the rootlets and fascicles. The changes in NCE were compared and contrasted with those observed in acute and chronic inflammatory demyelinative neuropathies.

Animals↗
PubMed1992

Myelin gangliosides of human peripheral nervous system: an enrichment of GM1 in the motor nerve myelin isolated from cauda equina.

Myelins of the PNS were isolated from human motor and sensory nerves of cauda equina, and their ganglioside compositions were compared. The predominant ganglioside in the human PNS myelins, both from motor and sensory nerves, was LM1 (sialosylneolactotetraosylceramide). Sialosyl-nLc6Cer and disialosyl-nLc4Cer, GD3, GM3, and GD1b were detected as common components of the two nerve myelins. Furthermore, it was revealed that the motor nerve myelin contained GM1 (about 15% of total gangliosides), whereas sensory nerve myelin contained only a trace amount of GM1 (less than 5%), by TLC analyses together with TLC immunostaining using anti-GM1 antibody. As for the disialoganglioside fraction, the content of GD1a, as well as that of GM1, differed in motor and sensory nerves. Thus, the different contents of the ganglioseries gangliosides in human motor and sensory nerve myelins were demonstrated.

Cauda Equina↗
PubMed1999

Neurocytoma of the cauda equina. Case report.

A case of a neurocytoma involving a nerve root of the cauda equina in a 46-year-old woman is reported. The patient presented with a 2-month history of progressive left lower-extremity weakness and pain and decreased ability to walk, as well as complaints of incomplete voiding. A magnetic resonance image revealed a 7-mm oval mass that was located intrathecally and extended from T-12 to L-1 and was adjacent to a nerve root. No lesions were identified at higher vertebral levels. The mass was excised. On histological examination it was found to have classical features of a neurocytoma. To the best of the authors' knowledge, this is the first report of a neurocytoma occurring in that region. A detailed histological description of this case and review of the pertinent literature are provided.

Cauda Equina↗