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Surgery
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
A 62-year-old woman with lower back pain and bilateral sciatica presents to her GP. On examination, there are bilateral lower motor signs in her lower limbs. Cauda equina syndrome is suspected. What is the termination of the spinal cord known as? (1)At what vertebral level does it occur in adults? (1)At what vertebral level does it occur at in newborns? (1)What are two possible causes of cauda equina syndrome? (2)Give two lower motor neurone signs. (2)What is the preferred imaging modality in suspected cauda equina syndrome? (1)What is the definitive management of this condition? (1)Give one potential complication if it is left untreated. (1)
Out-of-hours and emergency palliative care
Published in Rodger Charlton, Primary Palliative Care, 2018
Presentation may be insidious, with the patient being ‘off their legs’. SCC should be considered in any patient who has back pain radiating into the limbs, limb weakness, paraesthesia, sensory disturbance or urinary sphincter dysfunction. Pain is the commonest symptom, with 90% of patients reporting pain when questioned retrospectively after diagnosis. Patients with compression below the lower end of the spinal cord suffer from the separate but related ‘cauda equina syndrome’. Patients with sacral level compression may only show signs of sensory disturbance in the perineal region.
Spinal injuries
Published in S Asbury, A Mishra, KM Mokbel, M Fishman Jonathan, Principles of Operative Surgery, 2017
S Asbury, A Mishra, KM Mokbel, M Fishman Jonathan
The presence of some motor or sensory function below the level of injury. It may be indicated by the presence of ‘sacral sparing’ alone. Specific syndromes include the following. Brown-Sequard syndrome: loss of power, proprioception and light touch on the ipsilateral side, and loss of temperature and pain on the contralateral side due to the decussation of fibres.Anterior cord syndrome: loss of motor function, pain and temperature on the ipsilateral side, with a sparing of the dorsal columns (vibration and position sense).Central cord syndrome: decreased motor function found in the arms compared with that in the legs.Cauda equina syndrome: saddle anaesthesia, loss of bladder and bowel control and possible foot drop, resulting from lumbar and sacral nerve root injury.
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.
Neuro-urological sequelae of lumbar spinal stenosis
Published in International Journal of Neuroscience, 2018
Jason Gandhi, Janki Shah, Gargi Joshi, Sohrab Vatsia, Andrew DiMatteo, Gunjan Joshi, Noel L. Smith, Sardar Ali Khan
Although LSS is well defined, it may be difficult to diagnose due to its mimicry of other pathologies. Iliosacral joint disorder may also mimic LSS with low back pain radiating to the buttocks and thighs while standing and walking. Cauda equina syndrome should be included in the differential diagnosis; however, it is a neurological emergency, comprising a loss of tendon reflexes in the lower limbs, bowel and bladder incontinence, and saddle anaesthesia. Cervical or thoracic myelopathy should additionally be ruled out in patients who have vesicorectal voiding and upper motor signs [7]. It is also vital to consider benign prostatic hyperplasia as mentioned previously, in regard to genitourinary issues. Osteoarthritis of the hips or knees may also present exacerbated pain during walking. Although the pain in these conditions is usually localized to the involved joints, it may also radiate to the groin or buttocks. Konno et al. have developed a simple clinical diagnostic support tool to identify patients with LSS [49].
The use of Mechanical Diagnosis and Therapy (MDT) in patients with lower urinary tract symptoms (LUTS): case series
Published in Physiotherapy Theory and Practice, 2019
Cauda equina syndrome (CES) has historically been considered a rare complication of lumbar spine conditions and a surgical emergency that requires early decompression (Chau, Xu, Pelzer, and Gragnaniello, 2014). However, there are marked inconsistencies in the current evidence surrounding the etiology and clinical presentation of CES. Subclassifications of the definition of CES are ambiguous and should be avoided (Fraser, Roberts, and Murphy, 2009). Clinically, for a diagnosis of CES, one or more of the following must be present: (1) bladder and/or bowel dysfunction; (2) reduced sensation in the saddle area; and (3) sexual dysfunction, with a possible neurologic deficit in the lower limb (motor/sensory loss, reflex change) (Fraser, Roberts, and Murphy, 2009). The timing and effect of urgent surgical intervention for CES is debated. Based on the current state of research, the literature is not convincing that early surgical treatment is more efficacious than late surgical treatment (Mahadevappa, Persi, and Nesathurai, 2015). Akca et al. (2014) described four cases with sexual and sphincter dysfunction without LBP caused by L5-S1 disc herniation. The improvement of perineal sensory deficit after surgery was counteracted by a trend toward disturbed sexual function. With this debate and lack of clarity in the literature, it may be time to explore, with caution, the possibility that patients presenting with these symptoms may have a more promising conservative option than “observation and careful follow-up” (Mahadevappa, Persi, and Nesathurai, 2015). With careful monitoring of symptoms, which is an essential component of MDT, can some of these symptoms be reversed if a derangement is recognized and addressed appropriately?