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PubMedDate not supplied

Lumbosacral evoked potentials (LSEPs) and cortical somatosensory evoked potentials (SEPs) in patients with lesions of the conus medullaris and cauda equina.

Evoked potentials from unilateral stimulation of the posterior tibial nerve at the knee were recorded over the spinous processes S1, L4, L2, T12 and from the 'lower extremity' portion of the sensory cortex (Cz) in 29 patients who exhibited clinical and electromyographic signs of conus medullaris or cauda equina lesions. Simultaneous recording of the lumbosacral evoked potentials (LSEPs) and cortical somatosensory evoked potentials (SEPs) permitted evaluation of the relative effectiveness of the peripheral stimulus in eliciting responses in the lumbosacral segments of the spinal cord and in the cortex of the brain. In patients with cauda equina lesion, each major component of LSEP can be absent or the peak can have a reduced amplitude and a prolonged latency. The degree of impairment of the LSEP runs in parallel to the degree of severeness of the cauda equina lesion. The recording of LSEP responses with surface electrodes represents a reliable test for the detection of mild cauda equina abnormalities, but the surface recording technique is not sensitive enough to differentiate between severe incomplete and severe complete cauda equina lesions. On the other hand, concurrent recording of responses evoked at lumbosacral and cortical levels by the same stimuli did detect instances in which the first-order afferents were capable of delivering an adequate volley of impulses to evoke a sizeable cortical response without evidence of an associated postsynaptic response in the spinal cord. Such findings are good evidence of a problem localized in the gray matter of the spinal cord.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Urologic changes after cauda equina compression in dogs.

Relative degrees (25%, 50% or 75%) of constriction of the entire cauda equina at the seventh lumbar level were performed on eighteen pure bred female beagle hounds by surgically implanting a circular polyethylene loop with an imbedded stainless steel wire. The wire was mechanically constricted by external control and the degree of compression was confirmed by pre- and postoperative magnetic resonance imaging or computed tomography scanning. A control group of two dogs had laminectomy only. Neurologic function was evaluated daily. Cystometrics were performed on each dog after constriction had been present for three months. Cortical evoked potentials (CEPs) were obtained on all dogs preoperatively, immediately following constriction and at monthly intervals for three months. Dogs were sacrificed at three months and the cauda equina and spinal cord were examined histopathologically. Cystometric tracings were noted to become a flat line with 75% compression of the cord. Less compression had minimal effect on the cystometric curves. The mean latency, determined by cortical evoked potentials, was noted to increase by 3.2%, 7.8%, and 17.2% immediately after 25%, 50% and 75% constriction, respectively. Histologic changes ranged from occasional enlargement of the axons on the periphery of the cauda equina with 25% constriction to severe loss of all axons and atrophic roots at the level of the constricting band with 75% constriction.

Animals↗
PubMed1979

Cauda equina compression presenting as spontaneous priapism.

Disturbance of autonomic function is an unusual feature of compression of the cauda equina. A 61 year old man who had complete occlusion of the lumbar spinal canal with compression of the cauda equina from a large centrally prolapsed disc, had spontaneous priapism, precipitated by walking and relieved by resting. This symptom was comparable to claudication by compression of cauda equina. It subsided completely after surgical removal of a prolapsed L4-5 disc.

Aged↗
PubMed1997

Intraneural capillary hemangioma of the cauda equina.

A case of intraneural capillary hemangioma involving the dorsal root of a spinal nerve of the cauda equina is reported. The patient was a 41-year-old man with a 3-month history of intermittent left lumbosciatalgia. MRI and CT myelography showed a space-occupying mass at the level of the cauda equina. Laminectomy of L5 and complete removal of the lesion were performed without neurological problems. The clinical, diagnostic, and therapeutic aspects of hemangiomas of the cauda equina are analyzed.

Adult↗
PubMed1993

[Cauda equina syndrome in a Fleckvieh bull after a pathological fracture of the first sacral vertebra caused by a spindle cell sarcoma].

A 9 month old Simmental fattening bull was presented with signs of a cauda equina syndrome. An epidurographic examination was made after thorough clinical, neurological and routine radiographic examination. The cause of the cauda equina compression--a spindle cell sarcoma--was revealed by the pathologic-histologic examination. This tumor caused the compression of the cauda equina and pathologic transverse fracture of the body of the first sacral vertebra and cranial epiphyseal fracture of the 1st and the 3rd sacral vertebra as well as the separation of the arcus from the first and second sacral vertebral bodies. Some other diseases which can cause cauda equina syndrome are mentioned.

Animals↗
PubMed1991

Capillary hemangioma in the cauda equina: neuroradiological findings.

A case of capillary hemangioma of the cauda equina is reported. Myelography with water-soluble contrast material showed a complete obstruction of the contrast column at the L1-L2 level. Neither plain nor intravenously enhanced CT revealed the tumor. Spinal angiography showed a feeding vessel to the tumor and a faint tumor stain. Magnetic resonance imaging (MRI) showed a mass lesion of slightly higher than cauda equina intensity, which was clearly enhanced with Gd-DTPA. MRI, especially Gd-DTPA-enhanced study, plays the most important role in the diagnosis of a spinal capillary hemangioma. Spinal angiography was interesting in showing a tumour with a capillary blush.

Angiography↗
PubMed2005

Cauda equina tolerance to high-dose fractionated irradiation.

PURPOSE: To report late neurologic toxicity rates and clinical outcomes for patients treated with high dose fractionated radiation therapy using three-dimensional treatment planning and combined proton and photon beams to portions of the cauda equina (L2-coccyx). METHODS AND MATERIALS: Medical records of 53 patients treated to fields encompassing the cauda equina were reviewed for the onset of neurologic symptoms in the absence of local failure. All doses were normalized to equivalent dose delivered in 2-Gy fractions. Median cauda dose was 65.8 cobalt Gray equivalents (CGE) (range, 31.9-85.1). Median follow-up was 87 months (range, 14-217 months). RESULTS: Nineteen patients experienced local recurrences, and 13 others had neurologic toxicity. A total of 54% (i.e., 7/13) of the toxicities occurred 5 years or more after treatment. Median caudal dose was 73.7 CGE in the group with neurologic toxicity, and 55.6 CGE in those without. On multivariate actuarial analysis, cauda dose and gender were statistically significant for neurotoxicity at p = 0.002 and p = 0.017, respectively. The estimated tolerance doses 5 years from treatment, TD 5/5 and TD 50/5, were 55 CGE and 72 CGE, respectively, for males and 67 CGE and 84 CGE for females. The tolerance doses were about 8 CGE lower when estimated at 10 years from treatment. Disease-free survival rates at 5 and 10 years were 66% and 53%, respectively. CONCLUSIONS: This study suggests that the probability of neurotoxicity is a relatively steep function of dose to cauda equina (slope gamma50 = approximately 3). The cauda equina tolerance is greater for females than males by about 11 CGE (at 2 CGE per fraction). Extended follow-up is necessary to accurately assess neurologic damage and then differentiate that phenomenon from local recurrence; the traditional 5-year assessment has limited meaning in this population. Local control remains an issue for these patients, even with the radical doses used.

Actuarial Analysis↗
PubMed1999

[Cauda equina syndrome due to recurrent malignant lymphoma of the spinal cord. A case report].

A 50-year-old man noticed a mass in the right cervical region and presented to our hospital. He underwent biopsy of a cervical lymph node, which revealed non-Hodgkin's lymphoma (diffuse large B cell, lymphoblastic type) histologically. He was treated with chemotherapy (CHOP) and radiation, and achieved complete remission. Two months later, he was admitted because of distal pain and extensive numbness of the lower limb as well as weakness of the left leg. Lumbar MRI showed an area of abnormal intensity in the cauda equina. Cytological examination of cerebrospinal fluid showed class V (lymphoma cells), so he was diagnosed as having recurrent malignant lymphoma of the spinal cord. He was treated with intrathecal chemotherapy and irradiation. After the treatment the mass in the cauda equina disappeared and the neurological symptoms in his legs resolved. It is rare for malignant lymphoma to recur in the spinal cord, particularly the cauda equina. It is well known that cauda equina syndrome can be caused by vertebral lesions and primary spinal cord tumors, but it is also necessary to keep malignant lymphoma of the cauda equina in mind.

Aged↗
PubMed1989

Mobile schwannoma of the cauda equina diagnosed by magnetic resonance imaging.

Three cases of a mobile cauda equina schwannoma, preoperatively diagnosed by magnetic resonance imaging, are described. When dealing with tumors of the cauda equina, it is important to carry out a second magnetic resonance imaging scan after changes in posture, bearing in mind the possibility of mobility of the tumor.

Adult↗
PubMed1985

[Syndrome of redundant nerve roots of the cauda equina. Apropos of 2 cases].

Redundant nerve roots of the cauda equina (RNR) are considered to be extremely rare. This finding was reported for the first time in 1953 by Verbiest and since then several articles have being published on this subject. In an extensive review of the literature we have found 60 cases of RNR, 54 cases of which were operated including two new cases that we report in the present article. The RNR consist of elongated, tortuous and serpiginous nerve roots of the cauda equina. This disorder mainly affects males and the clinical history ranges from few months to three decades. The illness often start by a low back pain or sciatica associated or not with weakness or parasthesia of the lower limbs. There is sometimes a medullar claudication with gait ant sphincters disturbances. The electromyogram shows signs of chronic denervation and there is a high protein level in the CSF exam. X-rays of the lumbosacral spine show spondylarthrosis generally associated with a narrow spinal canal. The diagnosis is made by a lumbar myelogram which shows a partial or complete block of the column contrast. Serpentine defects suggest an arteriovenous medullar malformation, but the aortic angiogram is normal. At the opening of the dura-mater there is a sudden extrusion of the roots which are under pressure. The elongated roots are generally knotten or curled. One or several roots are very long but their diameter and aspect are normal. The treatment includes a decompressive lumbar laminectomy associated with a decompressive duroplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Cauda Equina↗
PubMed2006

Effects on improvement of blood flow in the chronically compressed cauda equina: comparison between a selective prostaglandin E receptor (EP4) agonist and a prostaglandin E1 derivate.

STUDY DESIGN: Vasodilatation was studied in a model of experimental chronic cauda equina compression using measurements of vessel diameter on video recordings. OBJECTIVE: The vasodilative effect was compared between a prostaglandin E2 receptor (EP) subtype agonists (EP4 agonist) and a prostaglandin E1 (PGE1) derivate. SUMMARY AND BACKGROUND DATA: Reduction of blood flow is one important pathogenic factor of neurogenic intermittent claudication (NIC) for lumbar spinal canal stenosis. It is known that PGE1 improves the mean walking distance in patients with cauda equina compression type of NIC. There are four subtypes of EP: EP1, EP2, EP3, and EP4. EP4 is located in vessels of pigs and rabbits. A highly selective EP4 agonist, which has effects on dilatation of pig and rabbit vessels, has recently been developed. One may therefore assume that this agonist may improve blood flow in the chronically compressed cauda equina. METHODS: A total of 25 dogs were used. A plastic balloon inflated to 10 mm Hg was placed under the lamina of the seventh lumbar vertebra for 1 week. OP-1206 cyclodextrin clathrate (OP-1206 CD: prostaglandin E1 derivate) and ONO-4819 CD (a highly selective EP4 agonist) were intravenously administrated. The following 5 experimental groups were assigned: animals in group OP (3) (n = 5) and Group OP (10) (n = 5) received 3 eta g/kg per minute and 10 eta g/kg per minute of OP-1206 CD, respectively; those in Group EP (3) (n = 5) and Group EP (10) (n = 5) received 3 eta g/kg per minute and 10 eta g/kg per minute of ONO-4819 CD, respectively; and those in the control group (n = 5) received saline. After 7 days, the cauda equina was exposed and blood vessels of the second or third sacral nerve root were identified using a specially designed operation microscope equipped with a video camera. The diameters of the observed blood vessels were measured on video-recordings every 10 minutes until 60 minutes after administrating OP-1206 CD or ONO-4819CD. RESULTS: In the Groups OP (3), OP (10), and EP (10), the blood vessels were dilated and blood flow increased after injection of the agents. In the Group EP (10), the vessel diameter and blood flow increased significantly compared with that in the other four groups. In contrast, the blood vessels contracted and the blood flow was reduced in the Group EP (3). CONCLUSIONS: Our results suggested that the EP4 agonist at high concentrations might be a potential therapeutic agent since it is expected to increase blood flow in nerve roots in patients with spinal canal stenosis.

Alprostadil↗
PubMed2000

Giant cauda equina schwannoma. A case report.

STUDY DESIGN: Case report. OBJECTIVES: To present a rare case of a giant schwannoma of the cauda equina. SUMMARY OF BACKGROUND DATA: Giant spinal schwannoma of the cauda equina, which involves many nerve roots, is rare and there is usually no ossification in the schwannoma. It is unknown whether or not complete excision is preferable if the tumor is located in the lumbar lesion. METHODS: A 57-year-old woman had a 10-year history of low back pain. Scalloping of the posterior surface of the vertebral bodies from L3 to the sacrum was found. Magnetic resonance imaging disclosed a giant cauda equina tumor with multiple cysts. Central ossification revealed by computed tomography and an unusual myelogram made the preoperative diagnosis difficult. RESULTS: The patient underwent incomplete removal of the tumor, decompression of cysts, and spinal reconstruction. The tumor was proved to be a schwannoma. The postoperative course was uneventful and she has been almost free from low back pain for 3 years and 4 months. CONCLUSIONS: Giant schwannoma in the lumbar spine region is usually excised incompletely, because complete removal had the risk of sacrificing many nerve roots. In spite of the incomplete removal of the tumor, the risk of recurrence is low.

Cauda Equina↗
PubMedDate not supplied

Diagnosis of cauda equina abnormalities by using electromyography, discography, and epidurography in dogs.

Electromyography (EMG), L7-S1 discography and epidurography were investigated in 15 dogs with clinical signs of cauda equina dysfunction and in 7 control dogs without such clinical signs. Electromyography of paraspinal and pelvic limb muscles was done in 13 of 15 affected dogs. An L7-S1 discogram followed by an epidurogram was performed in all 22 dogs using 20% iopamidol. Results of discograms, epidurograms, and gross necropsy examinations were normal in six of seven control dogs. The one dog in which these studies were abnormal had a mild L7-S1 disc protrusion that did not result in nerve root compression at necropsy. Electromyographic analysis was 100% accurate in predicting the presence or absence of cauda equina disease. None of the results of discograms were falsely negative. Twelve of 15 discograms in clinically affected dogs indicated dorsal disc protrusion, but 2 of these protrusions were found to be noncompressive at surgery (13% error). Abnormal epidurograms occurred in 9 of 15 clinically affected dogs. There was one false positive and two false negatives (20% error). Electromyography was a sensitive screening technique for the presence of cauda equina disease. Discography may be more sensitive for detection of L7-S1 disc protrusion than epidurography. An abnormal radiographic contrast study of the cauda equina may only be useful when combined with an abnormal EMG.

Animals↗
PubMedDate not supplied

Two cases of cauda equina syndrome following spinal-epidural anesthesia.

BACKGROUND AND OBJECTIVES: Cauda equina syndrome (CES) is a well-known complication of spinal and epidural anesthesia. Previous reports have implicated lidocaine, chloroprocaine, and procaine in its etiology, but not bupivacaine. METHODS: A 63-year-old man underwent transurethral resection of the prostrate for which he received bupivacaine with glucose intrathecally. Postoperative, he had difficulty in urination and defecation, and magnetic resonance imaging revealed spinal stenosis at the L1-L2 level. The second patient was a 70-year-old woman who underwent hip replacement surgery using a combined spinal-epidural technique. Postoperative, after 42 hours, when the epidural infusion of bupivacaine was stopped, the patient had difficulty in urination and defecation. No anatomical abnormality was found on magnetic resonance imaging. RESULTS: The two patients developed cauda equina syndrome following bupivacaine with glucose injected spinally, and bupivacaine without glucose injected in a combined spinal-epidural technique. CONCLUSIONS: This case report describes two cases of CES following the use of bupivacaine. The first patient had spinal stenosis which could explain this complication; however the explanation for CES in the second patient is uncertain and consequently speculative. We have discussed the possible contributing factors but believe that the etiology of CES in the second patient remains unknown.

Aged↗
PubMed1994

[Results of therapeutic management of vesico-urethral and anorectal disorders in 20 patients with cauda equina syndrome].

Twenty patients (7 females and 13 males) with cauda equina lesions (12 herniated lumbar disks, 4 tumours, and 4 compression fractures of the lumbar spine), were treated according to a standardized management of their urinary and digestive symptoms, after surgery. The bladder emptying inability was managed by Crédé manoeuver facilitated by appropriate drugs completed by self intermittent catheterization. The constipation was treated by non irritant osmotic laxatives, and defecation obtained by abdominal straining, was facilitated by a suppository. All the patients recovered a sphincteric autonomy, without invalidating incontinence. Within 3 to 6 months, eleven patients improved enough bladder emptying to stop drugs and self-catheterization. None presented urinary incontinence. Within the same time, 14 had a stool daily, but medical treatment of the constipation had to be carried on in all of the 20 patients. None of the patients had incontinence for the solid stools, but only the patients who improved (spontaneously or after biofeedback therapy) the voluntary anal sphincter contraction were continent for the gaz, and liquid stools. The intermittent self-catheterization release (a complete emptying of the bladder being achieved) was more frequent after tumor treatment than after herniated disk, or compressive fracture treatment; the same release happened in case of immediate management if compared with delayed management of the urinary symptoms. Adversely, the digestive recovering was not influenced by either the etiology of the cauda equina lesions or the therapeutic management delay. Defecography demonstrated anatomical disturbances of the rectoanal apparatus such as perineal descent and/or mucosal prolapse, which could be secondary to the abdominal straining necessary to complete bladder and rectum emptying.

Adult↗
PubMed1994

Filum terminale ependymoma revealed by acute cauda equina compression syndrome following intratumoral and spinal subarachnoid hemorrhage in a patient on oral anticoagulants.

A 65 year-old woman with a filum terminale ependymoma is reported, presenting with acute cauda equina compression syndrome due to intratumoural and subsequent spinal subarachnoid hemorrhage (SAH) following therapy with oral anticoagulants. Few cases of spinal ependymoma have been reported with an acute cauda equina compression syndrome as the initial and only symptom, and the unique feature of our patient's anticoagulant status has only been described once in this setting. Although intratumoural hemorrhage is very well known since the myxopapillary variant is unique to the cauda equina and consists of loose connective tissue and numerous small blood vessels that are prone to bleeding, spinal SAH is seldom seen and the different hypotheses about the pathophysiological mechanisms that might promote bleeding still remain unresolved and will be discussed in this paper, as well as the special clinical features of spinal SAH and some diagnostic and therapeutic implications. A review of the literature (Medline search 1983-1993) revealed only 13 cases, including ours, of spinal SAH due to cauda equina ependymoma, and the results of this review together with our findings are described in this paper.

Acute Disease↗
PubMed1978

Mobile schwannoma of the cauda equina. Case report.

A patient with a mobile schwannoma of the cauda equina is described. The wide discrepancy between the myelographic and surgical locations of the tumor is most unusual. Awareness of the possibility of such an extreme degree of motility is important when dealing with cauda equina tumors.

Cauda Equina↗