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PubMed2002

Cauda equina syndrome caused by intervertebral lumbar disk prolapse: mid-term results of 22 patients and literature review.

This retrospective study analyzes the mid-term results of 22 patients who underwent diskectomy following a diagnosis of cauda equina syndrome due to prolapsed intervertebral lumbar disks (mean follow-up: 3 years and 9 months). Postoperatively, 17 of 22 patients had complete urinary function recovery within the follow-up period, 4 patients had a persistent stress incontinence, and 1 patient, incontinent 4 years postoperatively, required catheterization. Thirteen of 17 patients had recovery of motor deficits, 14 of 21 of sensory deficits, and 13 of 15 patients regained perianal sensation. There was no statistically significant difference concerning the time between onset of symptoms and surgical decompression and subsequent outcome. Complete evaluation must include imaging and urodynamic investigations. After an accurate diagnosis and adequate operative treatment, postoperative results of cauda equina syndrome appear satisfactory.

Adult↗
PubMed1989

[Cauda equina syndrome in lumbar disc herniation].

During the past 5 years 10 patients suffering from cauda equina syndrome as a result of prolapsed disc were treated surgically. Although considerable time had elapsed between the onset of symptoms and the operation, most of the patients improved, at least partially. The syndrome is a rare complication of a common condition of the lower spine. Awareness of its possibility and identification of the early clinical picture are essential. An accurate history and detailed physical examination are the most important factors in early diagnosis. In 5 women and 4 men, who ranged in age from 28-60 and averaged 41 years, the disks involved were L5-S1 in 6, L4-L5 in 2 and L1-T12 in 1 case. Persistent disability was found in most of the patients, including 4 with bladder and 4 with sexual dysfunction. In 7 there was residual sensory loss and in 5 some degree of motor weakness. Earlier surgical treatment seems to be the most effective method for improving the results of treatment.

Adult↗
PubMed2002

[A case of parkinsonian syndrome caused by normal pressure hydrocephalus accompanied by the cauda equina neurinoma].

A case of parkinsonian syndrome caused by normal pressure hydrocephalus (NPH) accompanied by cauda equina neurinoma is reported. A 69-year-old woman presented with typical symptoms of parkinsonism, including akinesia, resting and postual tremor, and cog-wheel rigidity. CT scan of the brain revealed dilatation of ventricles, but she did not present dementia and urinary incontinence that are common symptoms in NPH. Her cerebrospinal fluid (CSF) pressure was normal, and her protein level was high at 2,970 mg/dl. An electroencephalogram (EEG) showed diffuse slow waves. An IMP-SPECT images of the brain showed diffuse reduction of radioisotope uptake. Levodopa was not effective in treating her parkinsonism. Removal of the tumor caused dramatic improvement in her parkinsonism. Her CSF protein level was normalized and EEG and SPECT images were improved after the operation. However, ventricular size on brain CT showed no change. It was considered that the causal mechanism of NPH was due to high protein levels in the CSF. The parkinsonism in this case was caused by dysfunction of the circuits linking the cortex, basal ganglia, and thalamus associated with metabolic disorder due to periventricular ischemia. Typical parkinsonism caused by NPH associated with spinal cord tumor has not been reported. When we examine a patient with parkinsonian syndrome caused by NPH, we should check the CSF protein level. And if that level is high, the possibility of spinal cord tumor should be considered.

Cauda Equina↗
PubMed1993

[Giant ependymoma of the cauda equina. Long-term development apropos of 7 cases].

Seven cases of giant ependymomas of cauda equina, extending from the conus medullaris to the sacrum, are reported. Mean age of the patients was 36 years. The initial symptoms were not specific, including low back pain and radiculalgias. However, in two cases, the clinical presentation was related to hydrocephalus. At the time of the operation, 6 patients presented with pain, weakness and sphincter dysfunction. The diagnosis of tumor was made after myelogram in all cases. Metrizamide enhanced CT scan has been performed in one case. None patient had preoperative magnetic resonance imaging (MRI) but MRI allowed the follow up in 5 patients and detection of local and remote recurrences in 4 cases. All the tumors were attached to the filum terminale, and unless extended from L2 to S1. Pathologically, 3 patients had tumors classified as myxopapillary and 4 of the cellular type. Two patients had gross total resection of the tumor at the initial operation. Five patients had initial biopsy to make a diagnosis and required subsequent surgery for radical excision after an average of 16.8 months. Radiation therapy has been performed in 1 case after biopsy, in 1 case after total resection (grade III) and in 2 cases after recurrences. Three patients died 1 year, 5 years, 12 years post-operatively. Among these 3 patients, 2 had recurrences. Four patients are alive. One patient has no recurrence 5 years after initial surgery. Another patient remains symptom free 7 years after surgery but MRI showed a local recurrence. The last two patients present recurrences 7 years and 8 years after surgery. These recurrences have been treated by surgical removal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Paraganglioma of the cauda equina: magnetic resonance imaging.

We report the clinical and imaging features of a paraganglioma of the cauda equina. Raised CSF protein caused an unusual appearance of the spinal canal below the obstruction. No specific identifying features were encountered; paraganglioma is uncommon in this site and usually thought to be an ependymoma or a neuroma; histopathological examination is necessary for correct diagnosis.

Cauda Equina↗
PubMed1987

Acute herniated nucleus pulposus with cauda equina compression syndrome following chemonucleolysis. Report of three cases.

Three cases of acute disc herniation causing cauda equina compression syndrome after chemonucleolysis are described. All three patients had myelographic blocks and, despite emergency decompression procedures, were left with residual neurological deficits. Recommendations are made regarding evaluation and therapeutic intervention, and possible etiologies of this problem are reviewed.

Acute Disease↗
PubMed1997

Paraganglioma of the cauda equina with associated intramedullary cyst: MR findings.

The MR imaging features of a paraganglioma of the cauda equina with associated spinal cord cysts are presented. MR imaging showed the tumor to be isointense with the spinal cord on all pulse sequences and to enhance homogeneously. The intramedullary cysts had increased signal intensity on proton density- and T2-weighted images, and involved the cervical and thoracic regions.

Cauda Equina↗
PubMed2002

[Intravascular large cell lymphoma revealed by diffuse telangiectasia and cauda equina syndrome].

BACKGROUND: Intravascular lymphoma is a rare disease with usually fatal outcome, characterized by the proliferation within the lumen of small blood vessels of neoplastic large lymphoid cells of B-cell origin. We report a case of intravascular lymphoma revealed by diffuse telangiectasia and cauda equina syndrome. CASE REPORT: A 64-year-old Vietnamese woman presented with unexpected fever and weight loss. Three months after the onset of the first symptoms, an oedema appeared on the lower limbs and the trunk, followed by the eruption of diffuse superficial telangiectasia. Neurologic examination revealed a cauda equina syndrome. The diagnosis of intravascular B cell lymphoma was established on cutaneous and muscular biopsy specimen. A moderate hemophagocytic syndrome was observed, confirmed by bone marrow biopsy. Corticosteroid therapy was started, followed by combination chemotherapy yielding complete response. Six months later death occurred, without evidence of relapse of intravascular lymphoma. DISCUSSION: Clinical presentation of intravascular lymphoma is often confusing, mimicking systemic disease, with a predilection for skin and nervous system involvement. Diagnosis is difficult and often an autopsy finding. Prognosis is generally poor, but favourable responses to chemotherapy have been observed after early diagnosis and treatment. The pathogenesis of intravascular lymphoma remains unknown. Dysfunction of cell-endothelial interaction affecting adhesion molecules has been suspected. The implication of Epstein-Barr virus in intravascular lymphoma remains controversial.

Female↗
PubMedDate not supplied

[Paraganglioma of the cauda equina with gangliocyte differentiation].

Clinicoradiologic and pathologic data of a patient with a paraganglioma of the cauda equina are described. The peculiar aspect of this rare case is the gangliocyte differentiation with mature ganglion cells scattered in the tumor. The histologic and ultrastructural features are similar to other described cases of this tumor, with Zellballen pattern and neurosecretory granules. The immunohistochemical studies are quite typical with positive staining with neuroendocrine markers (N.S.E., G.F.A.P.). An interpretation of these findings is made.

Adult↗
PubMed1990

Paraganglioma of the cauda equina. Report of 2 cases and review of 59 cases from the literature.

Paragangliomas of the cauda equina are not so rare as said in the literature. Two additional cases are presented with a global analysis of the 59 cases from the literature. The diagnosis of this pathology greatly benefit of the use of immunostainings as the cells are often neuron-specific enolase, neurofilament protein and somatostatin positive so that electron microscopy is thus no longer mandatory for establishing the diagnosis. In addition, we report the first magnetic resonance images of this tumor at this location.

Adult↗
PubMed1981

Cauda equina syndrome in ankylosing spondylitis. Anatomical, diagnostic, and therapeutic considerations.

This article describes a case of cauda equina syndrome associated with ankylosing spondylitis, and reviews 28 additional cases in the literature. The neurological symptoms appear late in the evolution of spondylitis, when it is at an inactive stage. The diagnosis is easily confirmed by myelography, with watersoluble contrast and performed in a supine position, and by computerized tomography (CT) scan of the lumbar spine. The typical features are dilated lumbar sac with multiple dorsal diverticula. The pathogenesis of this entity remains the subject of speculation. Arachnoiditis with subsequent adhesions is the most likely explanation. No treatment has proved helpful so far. Surgery is not indicated.

Adult↗
PubMed1995

The role of calcium deposition in the ligamentum flavum causing a cauda equina syndrome and lumbar radiculopathy.

Our report concerns five patients who underwent lumbar decompressive surgery for cauda equina syndrome and radiculopathy secondary to degenerative stenosis associated with calcium deposition in the ligamentum flavum. The resected ligamentum flavum showed diffuse to massive calcium crystal deposition with a histologically marked degeneration in the elastic fibres. Energy dispensive radiographic microanalysis confirmed the crystal to be calcium pyrophosphate dihydrate in all patients, hydroxyapatite mixed in three and calcium orthophosphate mixed in one. The deposition appeared to be a change that is associated with the degenerative process in the ligament and, in some cases having marked deposition in a localised event, it causes or aggravates the neurological symptoms.

Aged↗
PubMed2001

Extended posture of lumbar spine precipitating cauda equina compression arising from a postoperative epidural clot.

We report a patient with nonoperatively treated acute cauda equina compression arising from an epidural clot that developed after decompressive surgery for lumbar canal stenosis. A 43-year-old woman underwent lumbar laminotomy, and was symptom-free for 3 hours; but this was followed by paresis. Postoperative myelography showed obstruction of the contrast column at the level of the laminotomy; this was relieved by hyperflexion of the lumbar spine. With sustained hyperflexion of the lumbar spine, all neurologic deficits were completely resolved within 5 days. Lumbar lordosis may be present when a patient lies in the supine position on a flat bed with the hips and knees extended; this may exacerbate dural constriction caused by an epidural clot following posterior lumbar spinal surgery.

Adult↗
PubMed1992

Redundant nerve roots of the cauda equina caused by lumbar spinal canal stenosis.

To investigate pathogenesis of redundant nerve roots of the cauda equina, which were concomitant with severe lumbar spinal canal stenosis, six cadavers were examined anatomically and histopathologically, and quantitative analysis of nerve fibers was performed. In this anatomic study, it was observed that all the redundant nerve roots passed through the constriction of the spinal canal. No significant pathologic change was detected in the spinal ganglia and in the spinal cords except for the posterior column, in which dorsal redundant roots were entering. Redundant nerve roots of unequal length also were observed in the anatomic study. The spatial distribution of redundant nerve roots and the extent of degeneration of nerve fibers in them were established by these histopathologic and quantitative studies. These facts indicated a close causal relationship between redundant nerve roots and constriction of the spinal canal, and that the pathogenesis of redundant nerve roots was a squeezing force acting on the nerve roots at the area of spinal canal constriction.

Cauda Equina↗
PubMed1989

[Cauda equina syndrome developing during anticoagulant therapy].

A woman aged 70 years with rheumatic heart disease developed the cauda equina syndrome (CES) seven days after commencement of anticoagulation therapy. Investigation suggested an intraspinal haematoma with subarachnoid haemorrhage. The patient was considered to be inoperable. The untreated CES resulted in permanent neurological deficits.

4-Hydroxycoumarins↗
PubMed2000

[Acute myelopathy and cauda equina syndrome].

The high incidence of non-specific, benign back trouble often delays the diagnosis of specific causes of back pain and thus result in neurological deficits. Degenerative abnormalities in the cervical spine may narrow the spinal canal and result in acute myelopathy subsequent to minor injuries. Large cervical or lumbar disc herniations causing myelon, conus or cauda equina compression are rare but must not be overlooked. Spinal metastases may remain unrecognised for a long period and lead to the correct diagnosis only after presentation with neurological deficits. Acute myelopathy or cauda equina syndrome are indications for immediate diagnostic assessment and treatment in a spine centre.

Acute Disease↗
PubMed1982

Gangliocytic paraganglioma in cauda equina region, with biochemical and neuropathological studies. Case report.

Biochemical analysis of a nonfunctional paraganglioma in the cauda equina region demonstrates that its catecholamine content is predominantly dopamine with small amounts of noradrenaline and adrenaline. Scattered mature large neurons characterize the tumor as gangliocytic paraganglioma. Ultrastructural study shows intracytoplasmic neurosecretory granules in the neoplastic cells.

Adult↗