1/7. Lumbar herniated disc presenting with cauda equina syndrome. Long-term follow-up of four cases.BACKGROUND: cauda equina syndrome is a relatively rare presenting symptom of lumbar herniated discs. Early operative decompression is advocated, but it may not always restore the bladder function. In such cases, knowing the long-term outcome of bladder or sphincter disturbances is quite useful in planning the management of these patients. methods: hospital records of patients operated on for lumbar herniated discs were reviewed. charts and imaging studies of those patients who presented with classic cauda equina syndrome were analyzed. RESULTS: There were 4 patients (2.8%) of 144 consecutive surgical series of lumbar disc herniation, whose presenting symptom was classic cauda equina syndrome. Postoperatively, the patients had been followed at the clinic for a mean period of 6.4 years. Certain characteristic findings were noted on patients' neurological and radiological examinations. Although the recovery process of bladder function was very slow, taking months to years, all four patients achieved almost normal voiding with no major impairment of daily activities. CONCLUSIONS: Even if short-term recovery of bladder function is poor after lumbar disc surgery for cauda equina syndrome, the long-term outcome is not necessarily so. We should follow up on these patients with such measures as intermittent self-catheterization and drug therapy, expecting slow but steady recovery of bladder and sphincter function.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
2/7. Acute cauda equina syndrome after total knee arthroplasty as a result of epidural anesthesia and spinal stenosis.An unusual complication of epidural anesthesia performed for routine total knee arthroplasty is presented. Epidural catheter placement or removal resulted in an acute cauda equina syndrome in a patient with asymptomatic high-grade lumbar spinal stenosis at L3-4. The case is presented along with a literature review.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
3/7. Unexpected complication of attempted epidural anaesthesia: cauda equina syndrome.cauda equina syndrome after regional anaesthesia is a serious and devastating complication. Its occurrence after epidural anaesthesia is rare. We report a 46-year-old male who received epidural anaesthesia for ureterorenoscopic lithotripsy and developed cauda equina syndrome postoperatively. Despite one failed attempt at entering the epidural space with an epidural needle resulting in dural puncture, an epidural catheter was inserted and 20 ml pH adjusted lignocaine 2% with 1:200,000 adrenaline injected via the catheter without untoward event. The possible causes of this complication are discussed. Fortunately, this patient recovered almost completely ten months later.- - - - - - - - - - ranking = 2keywords = catheter (Clic here for more details about this article) |
4/7. Spontaneous hemorrhage of a spinal ependymoma: a rare cause of acute cauda equina syndrome: a case report.STUDY DESIGN: An interesting case of spontaneous bleeding from an ependymoma of the filum terminale is presented. OBJECTIVES: To document a rare case of rapid neurologic deterioration as a consequence of spinal tumoral hemorrhage and to highlight important issues regarding tumor histologic subtype and the impact of anticoagulation that have emerged from an illuminating review of the literature. SUMMARY OF BACKGROUND DATA: To our knowledge, there have been only 8 reported cases of hemorrhage from an ependymoma of the filum terminale or conus medullaris causing acute cauda equina syndrome. Bleeding is described in the pathology texts as being a consequence of the vascular architecture of the myxopapillary subtype and so postulated to be more common in this group. Anticoagulation is recognized to increase the frequency of tumoral bleeding, but no studies report its effect of severity of clinical presentation. methods: We report the case of a 57-year-old woman who developed nontraumatic acute cauda equina syndrome, including sphincter compromise. She underwent a lumbosacral laminectomy for evacuation of a hematoma, at which stage a filum terminale ependymoma was excised. Histopathologic analysis demonstrated it to be of a nonmyxopapillary subtype. RESULTS: The patient demonstrated gradual improvement of the neurologic deficit. At 12-month follow-up, her saddle area sensory deficit has resolved, her right lower limb is much stronger allowing her to walk long distances, and she is successfully performing intermittent self-catheterization of her bladder. CONCLUSIONS: The possibility of an underlying tumor should always be borne in mind so that adequate preoperative planning can be undertaken. The presence of the myxopapillary subtype should not prevent a clinician from excluding other reasons for hemorrhage, and counseling when reinstituting anticoagulation must include warning against a worse prognosis from any future hemorrhage.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
5/7. subclavian artery dissection and triple infarction of the nervous system.BACKGROUND: subclavian artery dissection is a rare entity. It is usually associated with anomalous aortic vasculature. Only with trauma or catheterization procedures is subclavian artery dissection with normal aortic vasculature reported. PATIENT: We describe a patient with intrascapular pain, an occipital headache, and 3 distinct infarctions in the nervous system. He had spontaneous subclavian artery dissection with normal aortic vasculature. CONCLUSION: subclavian artery dissections should be suspected in patients with intrascapular pain, occipital or cervical pain, and symptoms within the posterior circulation.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
6/7. cauda equina syndrome after epidural steroid injection: a case report.OBJECTIVE: Conventional treatment methods of lumbusacral radiculopathy are physical therapy, epidural steroid injections, oral medications, and spinal manipulative therapy. cauda equina syndrome is a rare complication of epidural anesthesia. The following case is a report of cauda equina syndrome possibly caused by epidural injection of triamcinolone and bupivacaine. CLINICAL FEATURES: A 50-year-old woman with low back and right leg pain was scheduled for epidural steroid injection. INTERVENTION AND OUTCOME: An 18-gauge Touhy needle was inserted until loss of resistance occurred at the L4-5 level. Spread of the contrast medium within the epidural space was determined by radiographic imaging. After verifying the epidural space, bupivacaine and triamcinolone diacetate were injected. After the injection, there was a reduction in radicular symptoms. Three hours later, she complained of perineal numbness and lower extremity weakness. The neurologic evaluation revealed loss of sensation in the saddle area and medial aspect of her right leg. There was a decrease in the perception of pinprick test. Deep-tendon reflexes were decreased especially in the right leg. She was unable to urinate. The patient's symptoms improved slightly over the next few hours. She had a gradual return of motor function and ability of feeling Foley catheter. All of the symptoms were completely resolved over the next 8 hours. CONCLUSION: Complications associated with epidural steroid injections are rare. Clinical examination and continued vigilance for neurologic deterioration after epidural steroid injections is important.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |
7/7. Reversible bladder denervation in acute polyradiculitis.A case of reversible bladder denervation in acute polyradiculitis is presented, in which both motor and sensory bladder involvement could be demonstrated using cystometry and denervation-hypersensitivity testing. attention is drawn to the differential diagnosis to cauda equina syndromes of other etiologies, and treatment with prompt catheter drainage is emphasized. Catheter removal should be guided by disappearance of denervation supersensitivity, and residual urine control by non-invasive methods is recommended.- - - - - - - - - - ranking = 1keywords = catheter (Clic here for more details about this article) |