scholarly journals Intramedullary Abscess byStaphylococcus aureusPresenting as Cauda Equina Syndrome to the Emergency Department

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Dimitrios Damaskos ◽  
Helene Jumeau ◽  
François-Xavier Lens ◽  
Philippe Lechien
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Low Back ◽  
Rare Entity ◽  
Sensory Disturbance ◽  
Motor Weakness ◽  
Intramedullary Abscess ◽  
History Of

Cauda equina syndrome (CES) is a rare entity presenting with low back pain, unilateral or bilateral sciatica, motor weakness of lower extremities, sensory disturbance in the perineal area, and urinary and/or faecal incontinence. Those symptoms are secondary to compression of the cauda equina. If not recognized, CES can lead to irreversible disabilities. We report the case of a 77-year-old lady who presented to the emergency department with a ten-day history of back pain as well as urinary incontinence.

Just the facts: Risk stratifying nontraumatic back pain for Cauda Equina Syndrome in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (5) ◽  
pp. 652-654
Author(s):  
Zoe Polsky ◽  
Margriet Greidanus ◽  
Anjali Pandya ◽  
W. Bradley Jacobs
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Bowel Movement ◽  
Chronic Back Pain ◽  
Cauda Equina ◽  
Digital Rectal Examination ◽  
Acute Onset ◽  
Clinical Exam ◽  
History Of

A 43-year-old male, with a history of chronic back pain, presents to the emergency department (ED) with acute onset chronic pain. He states he “tweaked something” and has been debilitated by back pain, radiating down both his legs, for 24 hours. He has not had a bowel movement but denies noticing any “saddle anesthesia.” His clinical exam is limited by pain, and it is difficult to determine if he has objective weakness. His perineal sensation is intact, as is his sensation upon digital rectal examination. The patient has a post-void residual of 250 mL, but you are unsure how to interpret this value. As an emergency physician, when should you suspect, and how should you evaluate cauda equina syndrome?

scholarly journals Posterior epidural migration of a lumbar disc herniation

2020 ◽  
Vol 11 ◽  
pp. 4
Author(s):  
Meryem Himmiche ◽  
Khalid Chakour ◽  
Mohammed El Faiz Chaoui ◽  
Mohammed Benzagmout
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Low Back ◽  
Case Description ◽  
Disc Material ◽  
Disc Herniations ◽  
History Of

Background: Posterior epidural migration of a lumbar disc fragment (PEMLDF) refers to the dorsal migration of disc material around the thecal sac that can lead to radiculopathy and/or cause a cauda equina syndrome. It is rare and the diagnosis is often just established intraoperatively. Case Description: A 50-year-old male with a chronic history of low back pain and psychosis presented with PEMLDF originating at the L4–L5 level. Conclusion: Lumbar disc herniations rarely present as PEMLDF resulting in symptoms varying from radiculopathy to cauda equina syndrome. These should be included among the differential diagnostic considerations for dorsolateral epidural lesions.

Appropriateness of Imaging Decisions for Low Back Pain Presenting to the Emergency Department: A Retrospective Chart Review Study

2021 ◽  
Author(s):  
Adrian Traeger ◽  
Gustavo C Machado ◽  
Sally Bath ◽  
Martin Tran ◽  
Lucinda Roper ◽  
...  
Keyword(s):  
Emergency Department ◽  
Low Back Pain ◽  
Back Pain ◽  
Chart Review ◽  
Imaging Modality ◽  
Cauda Equina ◽  
Retrospective Chart Review ◽  
Low Back ◽  
Review Study ◽  
Hospital Emergency Departments

ABSTRACT Background Imaging for low back pain is widely regarded as a target for efforts to reduce low value care. We aimed to estimate the prevalence of overuse and underuse of lumbar imaging in the Emergency Department. Methods Retrospective chart review study of five public hospital Emergency Departments in Sydney, Australia, in 2019/20. We reviewed the clinical charts of consecutive adult patients who presented with a complaint of low back pain and extracted clinical features relevant to a decision to request lumbar imaging. We estimated the proportion of encounters where a decision to request lumbar imaging was inappropriate (overuse) or where a clinician did not request an appropriate and informative lumbar imaging test when indicated (underuse). Results 649 patients presented with a complaint of low back pain of which 158 (24.3%) were referred for imaging. 79 (12.2%) had a combination of features suggesting lumbar imaging was indicated according to clinical guidelines. The prevalence of overuse and underuse of lumbar imaging was 8.8% (57 of 649 cases, 95%CI 6.8% to 11.2%) and 4.3% (28 of 649 cases, 95%CI 3.0% to 6.1%), respectively. 13 cases were classified as underuse because the patient was referred for an uninformative imaging modality (e.g. referred for radiography for suspected cauda equina syndrome). Conclusion In this study of emergency care there was evidence of overuse of lumbar imaging, but also underuse through failure to request lumbar imaging when indicated or referral for an uninformative imaging modality. These three issues seem more important targets for quality improvement than solely focusing on overuse.

Low Back Pain in a Child Associated With Acute Onset Cauda Equina Syndrome

2012 ◽  
Vol 32 (3) ◽  
pp. 271-276 ◽  
Author(s):  
Juan Pretell-Mazzini ◽  
Kudakwashe R. Chikwava ◽  
John Paul Dormans
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Acute Onset ◽  
Low Back

scholarly journals What is the incidence of cauda equina syndrome? A systematic review

2020 ◽  
Vol 32 (6) ◽  
pp. 832-841 ◽  
Author(s):  
Ingrid Hoeritzauer ◽  
Matthew Wood ◽  
Phillip C. Copley ◽  
Andreas K. Demetriades ◽  
Julie Woodfield
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Small Sample Size ◽  
Meta Analysis ◽  
Adult Population ◽  
Cauda Equina ◽  
Small Sample ◽  
Low Back ◽  
Patient Pathways

OBJECTIVECauda equina syndrome (CES) is a surgical emergency requiring timely operative intervention to prevent symptom progression. Accurately establishing the incidence of CES is required to inform healthcare service design and delivery, including out-of-hours imaging arrangements.METHODSA systematic literature search of MEDLINE, EMBASE, and Scopus was undertaken to identify original studies stating the incidence of CES, and the estimates were combined in a meta-analysis as described in the protocol registered with PROSPERO (registration no. CRD42017065865) and reported using the PRISMA guidelines.RESULTSA total of 1281 studies were identified, and 26 studies were included in the review. Data about CES incidence were available from 3 different populations: asymptomatic community populations, patients with nontraumatic low-back pain, and patients presenting as an emergency with suspected CES. The incidence of CES was 0.3–0.5 per 100,000 per year in 2 asymptomatic community populations, 0.6 per 100,000 per year in an asymptomatic adult population, and 7 per 100,000 per year in an asymptomatic working-age population. CES occurred in 0.08% of those with low-back pain presenting to primary care in 1 study, and a combined estimate of 0.27% was calculated for 4 studies of those with low-back pain presenting to secondary care. Across 18 studies of adults with suspected CES, 19% had radiological and clinical CES. Difficulties in comparison between studies resulted from the heterogeneous definitions of CES and lack of separation of more advanced CES with retention, which is unlikely to be reversible. In the studies of patients with suspected CES, the small sample size, the high number of single-center studies (18/18), the high number of studies from the United Kingdom (17/18), the retrospective nature of the studies, and the high number of abstracts rather than full texts (9/18) reduced the quality of the data.CONCLUSIONSFrom current studies, it appears that CES occurs infrequently in asymptomatic community populations and in only 19% of those presenting with symptoms. Determining accurate incidence figures and designing a bespoke service for investigation of patients with suspected CES would require a consensus clinical and radiological definition of CES and international multisite studies of patient pathways of investigation and management.

scholarly journals What happened to cauda equina fibers? Adhesive arachnoiditis

2020 ◽  
Vol 24 (5) ◽  
Author(s):  
Turgay Kara ◽  
Ömer Davulcu ◽  
Fatih Ateş ◽  
Fatma Zeynep Arslan ◽  
Halil Ibrahim Sara ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Spinal Surgery ◽  
Cauda Equina ◽  
Low Back ◽  
Foot Pain ◽  
Imaging Findings ◽  
Motor Weakness ◽  
Treatment History ◽  
Spinal Arachnoiditis

Spinal arachnoiditis may present with low back pain, foot pain, loss of sensation and motor weakness. In addition, some people may have syringomyelia due to impaired flow of cerebrospinal fluid. In the etiology, there are infections, intrathecal steroid or anesthetic injection, trauma, subarachnoid hemorrhage, myelographic contrast media, multiple spinal surgery and lumbar puncture history. The patient’s past treatment history, clinical and MRI examination are important in diagnosis. In this case, we aimed to discuss postoperative adhesive arachnoiditis which caused low back pain, and imaging findings in the light of literature. Key words: Adhesive arachnoiditis; Cauda equina; Pain; Anesthesia; Surgery; Imaging; MRI Citation: Kara T, Davulcu O, Ates F, Arslan FZ, Sara HI, Akin A. What happened to cauda equina fibers? Adhesive arachnoiditis. Anaesth. pain intensive care 2020;24(5): Received: 29 April 2020, Reviewed: 17 June 2020, Accepted: 18 June 2020

scholarly journals Orthopnea and fever in an elderly woman

2017 ◽  
Vol 11 (4) ◽  
pp. 399
Author(s):  
Claudio Tana ◽  
Silvio Di Carlo ◽  
Mauro Silingardi ◽  
Maria Adele Giamberardino ◽  
Francesco Cipollone ◽  
...  
Keyword(s):  
Emergency Department ◽  
Low Back Pain ◽  
Back Pain ◽  
Elderly Woman ◽  
Surgical Repair ◽  
Low Back ◽  
Shortness Of Breath ◽  
Recumbent Position ◽  
Radiological Findings ◽  
History Of

Orthopnea is a sensation of shortness of breath, which occurs in recumbent position and is usually improved by standing or sitting. The authors report a case of an 81-year-old woman presented to the Emergency Department with a two-week history of orthopnea, fever and low back pain resistant to analgesics. Radiological findings confirm the presence of a diafragmatic hernia, and clinicians should pay attention to any history of trauma, because their absence in symptomatic adult patients directs towards a congenital cause. A surgical repair should be promptly obtained to avoid further general and respiratory deterioration.

scholarly journals Development of a toolkit for early identification of cauda equina syndrome

2016 ◽  
Vol 17 (06) ◽  
pp. 559-567 ◽  
Author(s):  
Sue Greenhalgh ◽  
Carole Truman ◽  
Valerie Webster ◽  
James Selfe
Keyword(s):  
At Risk ◽  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Lower Limbs ◽  
Motor Deficit ◽  
Medical Setting ◽  
Low Back ◽  
Content Validation

AimTo develop a simple cauda equina syndrome (CES) toolkit to facilitate the subjective examination of low back pain patients potentially at risk of CES. To undertake preliminary validation of the content of the toolkit.BackgroundCES is a rare condition which can be very challenging to identify in a generalist medical setting.MethodA three phase iterative design with two stake holder groups; extended scope practitioners experienced in managing CES patients and CES sufferers.Toolkit developmentSynthesis of existing CES literature with CES patient data generated from in depth interviews.Toolkit validationContent validation of the draft toolkit with CES patients.Toolkit validationContent validation of the draft toolkit with extended scope physiotherapists.FindingsA three arm toolkit has been developed for use with patients considered by the clinician as at risk of developing CES (eg, worsening low back pain with symptoms/signs of progressive sensory-motor deficit in the lower limbs); patient expertise, clinical expertise, research and pathways. Uniquely, the toolkit drew upon the lived experiences of patients suffering from CES to inform the content.

scholarly journals Perirectal Abscess Masquerading as Cauda Equina Syndrome in an Otherwise Healthy 12-Year-Old Child

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Dylan Dean
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Pediatric Surgery ◽  
Care Center ◽  
Cauda Equina ◽  
Urgent Care ◽  
Urgent Care Center ◽  
Perirectal Abscess ◽  
Abnormal Gait

A 12-year-old boy was brought to an urgent care center for fever, back pain, and abnormal gait. In addition to back pain, the patient was found to be persistently febrile but also had decreased perianal sensation and bowel incontinence. He was therefore referred to the emergency department where his back pain improved without medication but he was still febrile with bowel incontinence and persistently decreased perianal sensation. An MRI was ordered to evaluate possible cauda equina syndrome and revealed a perirectal abscess. The child ultimately underwent an exam under anesthesia with pediatric surgery and had a drain placed. This case highlights a unique presentation of perirectal abscess masquerading as cauda equina syndrome. A discussion of important considerations in emergency room diagnosis and management is presented.

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