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Thermography by Specialty
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Lumbar spinal stenosis is technically known as Cauda Equina Compression Syndrome. The Cauda Equina (CE) is a bundle of peripheral nerves that exits the adult spinal cord at the conus medularis about the level of T12 and courses downwards, contained in and protected by the dura mater and bathed in cerebrospinal fluid. Individual CE nerves exit the bony spinal canal as they reach their corresponding lumbar and sacral dermatomal levels. Patients with LSS develop pain in the lower extremities on standing or walking due to increased pressure on the CE by venous congestion or bony impingement on the dura. As this pressure creates temporary partial nerve damage due to reduced local blood flow, sympathetic vasoconstrictor tone is increased over the lumbar and sacral skin areas, which become demonstrably cool. The areas over the buttocks (sacral nerves) and the quadriceps (lower lumbar nerves) best demonstrate this decrease in temperature.
Anatomy of the head and neck
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
The sensory and motor nerve roots fuse and merge into a single spinal nerve that leaves the vertebral canal via the intervertebral foramen. Leaving the foramen, the emerging nerves divide into anterior and posterior rami, each containing both motor and sensory fibres. The length of the spinal nerve within the vertebral canal increases progressively down the length of the cord, until after termination of the cord itself at the level of the second lumbar vertebra. Below this level, the nerves alone form a bundle known as the cauda equina within the vertebral canal.
Trauma of the Brain and Spinal Cord
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Fernando D. Goldenberg, Ali Mansour
Cauda equina syndrome: characterized by injury to the nerves located below the L1 region of the spine, resulting in radicular pain, urinary retention, partial or complete loss of sensation in the saddle area, and weakness of the lower extremities. The deficits in this condition are usually asymmetric or unilateral. In some cases, these nerve roots can regenerate and recover function.
Lymphomatosis cerebri with cauda equina lymphoma
Published in International Journal of Neuroscience, 2021
Gang Deng, Ran Tao, Dai-Shi Tian, Jun-Li Liu
To the best of our knowledge, the present report is the first to describe LC with simultaneous cauda equina involvement, both of which are rarely encountered in patients with PCNSL [9]. The involvement of the cauda equina was demonstrated by PET/CT and lumbar MRI. Cauda equina syndrome generally manifests as subacute, progressive lower limb paresthesia, muscular weakness, or bladder and/or rectal dysfunction, all of which were absent in this patient. The thickening and enhancement of cauda equina in MRI must be differentiated from inflammatory disorders and other neoplasms [19]. However, infection was unlikely because the CSF cell count was normal and no infectious agent was detected. Metastasis was also unlikely because no primary site was found. Biopsy of the nerve roots may be indicated in intractable cases. Despite no supportive evidence from nerve root biopsy, this patient was diagnosed with cauda equina lymphoma undoubtedly in light of the PET/CT results, lumbar MRI, and brain biopsy.
Intraneural haemangioma of peripheral nerves
Published in British Journal of Neurosurgery, 2020
Susanna Bacigaluppi, Pietro Fiaschi, Alessandro Prior, Nicola L. Bragazzi, Paolo Merciadri, Sergio Gennaro
Cavernous haemangiomas involving peripheral nerves are rare. We identified 41 cases of heamangiomas involving peripheral nerves (Tables 1 and 2) including ours and we believe this to be largest series to date. Most cases described were located on cranial nerves, spinal roots or involved the cauda equina. Age ranged from 4 to 64 years (mean 23.4, standard deviation 17.3, median 16 years). Male:female ratio was 1:1,7. 31 cases involved nerves of the upper extremity and in 10 cases only the lower extremity nerves were affected. The right side was most frequently involved (61.5%). Maximum size at presentation varied between 1 and 10 cm. In almost all cases tumefaction or a palpable mass was reported. In 52.6% (20 out of 38) sensory disturbance was described, and in 28.9% (11 out of 38) a motor deficit was present. Spontaneous or evoked pain occurred in 67.5% (27 out of 40). Surgical excision was performed in all with no permanent deficit, except for one patient where the haemangioma was particularly invasive and the affected limb was amputated.27 In another case, the haemangioma was considered unresectable without injuring the intact ulnar nerve and a transposition from the sulcus nervi ulnarii was performed to avoid nerve injury during mechanical stress leading to swelling of the haemangioma.18 Finally, in an immunosuppressed patient following liver transplant, a biopsy of the sciatic nerve was performed for diagnostic purposes.39
Impact of body fat distribution and sarcopenia on the overall survival in patients with spinal metastases receiving radiotherapy treatment: a prospective cohort study
Published in Acta Oncologica, 2020
B. J. Pielkenrood, P. R. van Urk, J. M. van der Velden, N. Kasperts, J. J. C. Verhoeff, G. H. Bol, H. M. Verkooijen, J. J. Verlaan
A total of 310 patients with spinal metastases treated with palliative radiation therapy was included. Median follow-up was 202 days (IQR 73–576) and overall survival rates after 90 and 365 days were 71% and 36% respectively. The majority of patients was male (63%) (Table 1). The most common primary tumour originated from the lung (28%), followed by prostate and breast (27% and 18% respectively). Non-osseous metastases were present in 152 patients (49%), 22% of all patients had liver metastases and 3% had brain metastases. In 9% of the patients, neurological symptoms as a result of epidural compression of the spinal cord/cauda equina/nerve roots were present. Of these patients, 18 (6%) had ASIA-scale grade D, 7 (2%), 2 (0.6%), 1(0.3%) had ASIA scale C, B and A respectively [24]. A minority of the patients (n = 115, 37%) received concurrent systemic therapy. There was no collinearity between any variables, as all VIFs were <5. Partial residuals using the Schoenfeld residuals method showed a linear relationship between residuals and continuous data. Missing data was found in 180 patients (58%), the majority of missing cases was found in the Karnofsky performance score (n = 134, 43%) and/or the patient’s height (n = 93, n = 30%) which is necessary to determine sarcopenia. Comparison between patients with and without at least one missing value can be found in Supplementary Table 1. Supplementary Figures 1 and 2 show the convergence plots of the imputation of the KPS and height.