Cauda equina compression syndrome in a child due to lumbar disc herniation

Introduction Cauda equina syndrome with sphincter dysfunction is an uncommon and feared complication of lumbar disc herniation.Case report Lumbar disc disease in the pediatric age has been reported infrequently, but to the best of our knowledge, this is the first pediatric case of acute lumber disc herniation presenting with caudal compression.     

Cauda equina syndrome revealing neuroblastoma

IntroductionNeuroblastoma is the most common solid tumor of childhood. Neurological involvement is rare resulting from cord or nerve compression.Case reportA 7-year-old child was hospitalized for cauda equina syndrome. MRI showed retroperitoneal lesion with dumbbell intradural spreading. Blood and urinary catecholamine level were elevated confirming the diagnosis of neuroblastoma. She was treated with chemotherapy alone with partial neurological recovery.Discussion and conclusionCauda equina compression revealing neuroblastoma is exceptional especially at an early phase in the youngest patients. Treatment is based on surgical resection and/or chemotherapy and/or radiation therapy. Long-term prognosis is sometimes poor with neurological sequels.     

Cauda equina syndrome complicating pneumococcal meningitis

A 14-month-old female with pneumococcal meningitis presented with flaccid paraplegia, saddle anesthesia, and bladder and bowel dysfunction. Magnetic resonance imaging of the spine demonstrated intense gadolinium enhancement of the cauda equina, whereas the conus medullaris appeared normal. This finding indicated that lumbosacral polyradiculopathy caused her symptoms.     

Cauda equina syndrome associated with multiple lumbar arachnoid cysts in ankylosing spondylitis: improvement following surgical therapy.

A case of cauda equina syndrome with multiple lumbar arachnoid cysts complicating ankylosing spondylitis (AS) is described. The value of computerised tomography (CT) and magnetic resonance imaging (MRI) as a non-invasive means of establishing the diagnosis is emphasised. In contrast to previously reported cases the patient showed neurological improvement following surgical therapy. Surgery may be indicated in some patients, particularly when there is nerve root compression by the arachnoid cysts and when the patient is seen early before irreversible damage to the cauda equina has occurred.     

Cauda equina syndrome with normal MR imaging

The aim of this study was to compare the clinical characteristics of patients with and without abnormal MR imaging admitted to a neurosurgical unit with suspected cauda equina syndrome using a retrospective study of consecutive admissions to a regional neurosurgical unit over a 10-month period. Clinical details were obtained from the case notes. A lumbar spine MR scan to investigate possible cauda equina syndrome was performed in 66 patients. There were no significant differences between those with abnormal imaging (n = 34, 52%) and those with a normal scan (n = 32, 48%) in respect of sex, clinical history or features recorded on examination. Those with normal imaging had a high frequency of weakness (n = 18, 59%), saddle numbness (n = 17, 57%), leg numbness (n = 24, 80%), urinary incontinence (n = 13, 54%) and urinary retention (n = 9, 53%). A large number of patients present to neurosurgical units with symptoms suggestive of cauda equina syndrome without any radiological evidence of structural pathology. While some may have had an alternative organic cause, we propose that these symptoms may have a “functional” origin in many patients.     

Cauda equina syndrome secondary to long-standing ankylosing spondylitis

Fourteen patients with cauda equina syndrome secondary to long-standing ankylosing spondylitis are described. The roughly symmetrical neurological deficits were very slowly progressive and began long after the onset of the spondylitis, usually well after the rheumatological symptoms had stopped. Eventually every patient had cutaneous sensory loss in the fifth lumbar and sacral dermatomes. All patients developed urinary sphincter disturbances of a lower motor neuron type. There was prominent loss of rectal sphincter tone, and all but 2 patients had bowel complaints, including incontinence and severe constipation. Seven patients had mild to moderate weakness in the lumbosacral myotomes. Seven patients had pain in the rectum or lower limbs. Electromyographic abnormalities were consistent with multiple lumbosacral radiculopathies. Myelography and computed tomographic scanning of the lumbosacral spine showed characteristic enlargement of the caudal sac and dorsal arachnoid diverticula that had eroded the laminae and spinous processes. Recognition of this syndrome, coupled with computed tomographic scanning of the lower spinal canal, allows one to omit myelography, a procedure that is difficult because of the associated spine abnormalities. Surgical intervention should be avoided.     

Cauda equina syndrome caused by Tarlov's cysts--case report

Perineural Tarlov cysts located on lumbo-sacral roots can be a cause of cauda equina syndrome. OBJECTIVES: 1) To draw attention to the fact that multiple Tarlov lumbo-sacral perineural cysts can produce serious movement disturbances. 2) To document the usefulness of the magnetic resonance imaging in noninvasive diagnosis of perineural cysts. CASE DESCRIPTION: A male patient, 80 years of age, suffered from progressive weakness of lower limbs, which caused an increasing drop of the feet. The disease began in August 2000, following a long journey by train. The patient additionally complained of urinary incontinence as result of sneezing, coughing or fast walking. The urologist did not find prostatic gland hypertrophy. An examination by the internist revealed atheromatous myocardiopathy in circulation failure stage. Magnetic resonance imaging showed multiple perineural cysts up to 15 mm in diameter on lumbo-sacral roots. This clinical picture, supported by the magnetic resonance imaging allowed to recognize cauda equina syndrome caused by Tarlov lumbo-sacral perineural cysts. DISCUSSION: This case is a reminder, that part of perineural cysts, particularly multiple, can be a cause of nerve roots injury, and their lumbo-sacral location can produce cauda equina syndrome. As reported by Zarski and Leo, Tarlov cysts were cause of 7.3% of pain syndrome cases 2 patients in the study group showed lower limb claudication. Magnetic resonance imaging of patients with back pain, performed by Paulsen, Call and Murtagh, revealed that Tarlov cysts occurred in 4.6% of patients, but only 1% had the symptoms connected with the presence of those cysts. In available Polish literature no report has been found referring to fixed cauda equina syndrome which was caused by multiple cysts revealed through the magnetic resonance imaging of spinal canal. Only Zarski and Leo, discussing the correlation between the clinical and radicographic picture, described transient cauda equina syndrome in two patients who, beside Tarlov cysts, were also found to have intervertebral lumbosacral disc herniation. Tarlov was the first to describe well documented cauda equina syndromes caused by cysts on the lumbo-sacral roots. It is necessary to emphasize the established role of magnetic resonance of spinal canal in the diagnosis of perineural cysts on the lumbo-sacral roots as well as other anatomical anomalies of cerebrospinal fluid spaces. Despite the fact that cauda equina syndrome in the case reported here was a serious complication of multiple Tarlov cysts in the lumbo-sacral region, a surgical treatment was not undertaken; in such cases this treatment should be the chosen procedure. CONCLUSION: Multiple perineural Tarlov cysts in lumbo-sacral region, without disc herniation or other cause of vertebral canal stenosis, can produce cauda equina syndrome.     

Cauda equina paraganglioma

Two paragangliomas resected from the cauda equina had similar morphology, both containing cells having dense core secretory granules with no associated sustentacular or supporting cells. The cells were arranged in characteristic lobules that were surrounded by basement membrane and separated by a fibrovascular stroma. This tumor, although rarely found elsewhere in the central nervous system, does occur in the region of the filum terminale, and causes a clinical syndrome typical of tumors in that area.     

Cauda equina syndrome caused by a migrated bullet in dural sac

Cauda equina syndrome (CES) is a serious neurological condition and the most common cause is a central disc herniation. Migration of a bullet down the spinal canal is uncommon. In this report, the authors present an unusual case of cauda equina syndrome caused by a migrated bullet in dural sac. The patient's cauda equina syndrome was related to possible compression of cauda equina resulting from both bone fragments in L1 level and bullet itself in S2 level. The patient's symptoms and neurological deficits resolved considerably after surgery. In our opinion, it is important to pay attention to diversity of injury when confronted with a gunshot wound. It is essential to perform early and sufficient surgical decompression of the cauda equina to provide a better postoperative neurological recovery.     

The redundant nerve root syndrome of the Cauda equina

The redundant nerve root syndrome is defined as the association of high-grade extradural lumbar spinal stenosis with large, elongated and tortuous nerve roots. Acquired elongation of nerve roots due to the mechanical trapping at the level of lumbar spinal stenosis is assumed to be the possible mechanism. It is believed that the cause is a squeezing force due to the chronic compression. The most common clinical symptoms are low back pain and leg pain. Although lumbar spinal canal stenosis is common, the entity has rarely been discussed in the literature. Here we present the MR imaging and intraoperative appearance of the condition with a brief discussion in a 71-year-old woman.     

Cauda equina syndrome in ankylosing spondylitis: a report of six cases.

Six patients with ankylosing spondylitis and features of a cauda equina syndrome are described. The myelographic findings are discussed in relation to the pathogenesis of the disorder and its natural history. Present experience suggests that the cauda equina syndrome is a more common complication of ankylosing spondylitis than is usually thought.     

Cauda equina syndrome with total myelographic block (author's transl)]

Twenty-seven cases of complete subarachnoid block discovered through myelography are analysed with regard to the causes of obstruction, the neurologic symptoms, and the cerebrospinal fluid. The neurologic signs in cases of cauda equina compression, most often caused by massive disc protrusions (20 patients), vary considerably and rarely correspond to the gross myelographic findings. Bilateral neurologic symptoms of any degree with or without sphincter disturbance were observed in 21 among 27 cases and are signs of cauda compression. In contrast to cases of sciatica with unilateral root compression and radicular symptoms neurological symptoms are not reliable in revealing the site of the lesion in cases of massive central disc protrusions. Therefore radiculography (myelography of the cauda equina) is necessary for diagnosis. In addition to the well-known elevation of the spinal fluid protein and pleocytosis, the presence of neutrophile granulocytes is frequently found (11 of 20 cases) in cytological analysis.     

Cauda equina syndrome due to disk herniation: Long-term functional prognosis

ObjectiveCauda equina syndrome (CES) caused by lumbar disk extrusion is classically considered an indication of urgent surgery. CES can be subdivided into CESI (incomplete CES) and CESR (complete CES with urinary retention and incontinence). This paper evaluates the long-term functional outcome of a CES cohort operated on due to disk herniation.MethodsSingle-center retrospective observational study. CES patients due to disk herniation that underwent surgery between 2000 and 2016 were included in the study. Demographic data, time intervals to diagnosis and surgery, preoperative neurologic status and outcome at the end of follow up were recorded.ResultsTwenty-two patients were included (median age 44 years). Eight patients were CESR and 14 CESI. Median time from symptom onset to diagnosis was 78 h (range, 12–720 h), and from diagnosis to surgery 24 h (range, 5–120 h). Median follow up was 75 months (range, 20–195 months). At the end of follow up, in the CESR group (median time from diagnosis to surgery, 23 h) only pain significantly improved after surgery (p = 0.007). In the CESI group (median time from diagnosis to surgery 23 h) low back pain, sciatica and urinary sphincter function significantly improved (p < 0.001). There were no significant differences between early (<48 h) operation (n = 4) and late (n = 18) in terms of sphincter recovery (Fisher's Exact Test, p = 0.076).ConclusionPain associated to CES improved both in the CESI and CESR groups. However, urinary sphincter impairment significantly improved only in the CESI group. No significant differences were found regarding long-term functional outcome between early and late surgery.