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The Orthopedic Clinics of North America Apr 2022Cauda equina syndrome (CES) involves compression of some or all of the lumbar and sacral peripheral nerve roots. However, there is a lack of consensus in the literature... (Review)
Review
Cauda equina syndrome (CES) involves compression of some or all of the lumbar and sacral peripheral nerve roots. However, there is a lack of consensus in the literature regarding the exact diagnosis criteria in this patient population. Much of the pathophysiology has been studied regarding the onset of this condition; however, the long-term effects are not able to be accurately predicted at this time. Recent literature has associated timing to surgical decompression, severity of symptoms at time of onset, and involvement of bladder dysfunction as prognostic indicators of CES.
Topics: Cauda Equina; Cauda Equina Syndrome; Decompression, Surgical; Humans; Polyradiculopathy; Prognosis
PubMed: 35365269
DOI: 10.1016/j.ocl.2021.11.010 -
Best Practice & Research. Clinical... Apr 2005Diabetic thoracic polyradiculopathy usually causes severe, chronic abdominal pain in patients with type 2 diabetes of variable duration. Other diabetic complications,... (Review)
Review
Diabetic thoracic polyradiculopathy usually causes severe, chronic abdominal pain in patients with type 2 diabetes of variable duration. Other diabetic complications, weight loss and paretic abdominal wall protrusion are common. Sensory, motor and autonomic functions are affected. The diagnosis can be made from the characteristic history, physical examination findings, paraspinal electromyography, and other procedures. The differential diagnosis includes postherpetic neuralgia, abdominal wall pain, malignancy, and other spinal disorders. The pathology appears to be immune-mediated neurovasculitis resulting in ischemic injury. Traditional therapy is symptomatic, but recent pathological findings and clinical experience suggest that immunotherapy may be effective.
Topics: Abdominal Pain; Adult; Diabetic Neuropathies; Diagnosis, Differential; Humans; Male; Polyradiculopathy; Thoracic Nerves
PubMed: 15833693
DOI: 10.1016/j.bpg.2004.09.003 -
Clinical Infectious Diseases : An... Aug 1998Using the MEDLINE database, we evaluated 103 cases of AIDS-related cytomegalovirus (CMV) polyradiculopathy (PRP). In 13% of cases, PRP was the initial manifestation of... (Review)
Review
Using the MEDLINE database, we evaluated 103 cases of AIDS-related cytomegalovirus (CMV) polyradiculopathy (PRP). In 13% of cases, PRP was the initial manifestation of AIDS. Hyporeflexia was present in 100% of cases; lower limb weakness, in 100%; urinary retention, in 94%; paresthesia, in 79%; sensory loss, in 80%; and a Babinski's sign, in 16%. Mean cerebrospinal fluid (CSF) parameters +/- SD were as follows: white blood cell count, 651 +/- 1,053 x 10(6)/L; protein level, 2.28 +/- 1.78 g/L; and CSF/serum glucose ratio, 0.48 +/- 0.17. Gadolinium enhancement of meninges on a magnetic resonance image and abnormalities on a myelogram were noted in 31% and 17% of cases, respectively. Mean survival time +/- SD was 5.4 +/- 1.8 weeks for untreated patients and 14.6 +/- 9.4 weeks for patients treated with ganciclovir (P < .0001), but it was only 7.2 +/- 3.0 weeks for patients receiving ganciclovir treatment at the onset of PRP. CMV-related PRP is an uncommon but distinctive complication of AIDS. Early diagnosis is possible, and other causes can be excluded by lumbar magnetic resonance imaging and by the presence of typical CSF changes, as shown by polymerase chain reaction of CMV. Retrospectively, survival time for naive patients was increased by ganciclovir therapy and may even be underestimated in this evaluation of historical reports.
Topics: AIDS-Related Opportunistic Infections; Adult; Antiviral Agents; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Male; Middle Aged; Polyradiculopathy; Prognosis; Survival Analysis
PubMed: 9709885
DOI: 10.1086/514663 -
Journal of the Neurological Sciences Jun 2009We report the case of a 43-year-old woman who developed multiple cranial nerve palsy, the symptoms of which included hyposmia, visual loss, facial hypoesthesia, facial... (Review)
Review
We report the case of a 43-year-old woman who developed multiple cranial nerve palsy, the symptoms of which included hyposmia, visual loss, facial hypoesthesia, facial weakness, dysphagia, gustatory disturbance, and sensory disturbance of the trunk and ulnar side of the bilateral arms. The clinical features included swelling of the bilateral hilar lymph nodes, uveitis, an elevated serum angiotensin-converting enzyme level, and negative tuberculin reactions, which led to a diagnosis of neurosarcoidosis. Her symptoms improved after administration of steroids. An elevated cerebrospinal fluid cell count and protein level, a low-frequency F-wave and slightly decreased sensory nerve action potentials in bilateral ulnar nerves by nerve conduction studies, and normal findings in the spine by magnetic resonance imaging suggested that truncal hypoesthesia was caused by polyradiculopathy. Although rare, in patients with neurosarcoidosis, truncal polyradiculopathy is noteworthy findings in addition to cranial nerve palsy.
Topics: Adult; Cranial Nerve Diseases; Diagnosis, Differential; Female; Humans; Neural Conduction; Polyradiculopathy; Sarcoidosis
PubMed: 19339022
DOI: 10.1016/j.jns.2009.03.005 -
Clinical Infectious Diseases : An... Jul 1993Neurological syndromes attributed to cytomegalovirus (CMV) in patients infected with human immunodeficiency virus (HIV) include encephalitis, myelitis, and peripheral... (Review)
Review
Neurological syndromes attributed to cytomegalovirus (CMV) in patients infected with human immunodeficiency virus (HIV) include encephalitis, myelitis, and peripheral neuropathy. More recently, polyradiculopathy due to CMV has been described. We review the literature and describe two patients with CMV polyradiculopathy whose conditions improved only after prolonged therapy with ganciclovir. Patients typically are young men who are severely immunocompromised and have had other opportunistic infections. The syndrome is characterized by subacute onset of leg weakness and numbness progressing to paraparesis or paraplegia. Bladder dysfunction is common. In many patients, CMV may be identified elsewhere; concomitant retinitis is common and often subclinical. Laboratory studies commonly show an increased number of neutrophils in CSF and hypoglycorrhachia. Electromyography and nerve conduction studies support the diagnosis. Imaging studies may be most useful to exclude spinal lesions. Without treatment prognosis is poor. Survival time is improved and symptoms often abate, sometimes dramatically, with ganciclovir therapy. Improvement of conditions may be rapid but can take months, as illustrated by these two cases. Once initiated, ganciclovir should be administered indefinitely to patients with CMV polyradiculopathy.
Topics: AIDS-Related Opportunistic Infections; Adult; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Polyradiculopathy
PubMed: 8394748
DOI: 10.1093/clinids/17.1.32 -
Archives of Physical Medicine and... Aug 1997Herpes zoster infection, resulting from reactivation of the dormant varicella zoster virus in the dorsal root ganglia, usually causes a painful dermatomal vesicular...
Herpes zoster infection, resulting from reactivation of the dormant varicella zoster virus in the dorsal root ganglia, usually causes a painful dermatomal vesicular rash. Rarely, associated peripheral motor weakness is present, the mechanism of which is unclear. Three patients are reported who had focal limb muscle weakness associated with zoster infection. Physical and occupational therapy played a key role in motor function recovery of the patients, yet emphasis on the rehabilitation of postherpetic motor weakness is lacking in the literature. Physiatrists evaluating patients with limb muscle weakness following herpes zoster infection should be alert to this condition. The clinical syndrome of herpes zoster radiculopathy and the rehabilitation of these patients are discussed.
Topics: Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Female; Herpes Zoster; Humans; Male; Occupational Therapy; Physical Therapy Modalities; Polyradiculopathy
PubMed: 9344310
DOI: 10.1016/s0003-9993(97)90204-5 -
British Journal of Hospital Medicine... Nov 2016
Topics: Diagnosis, Differential; Disease Management; Humans; Lumbosacral Region; Magnetic Resonance Imaging; Medical History Taking; Polyradiculopathy; Radiography; Sciatica; Symptom Assessment
PubMed: 27828743
DOI: 10.12968/hmed.2016.77.11.C180 -
Internal Medicine (Tokyo, Japan) 2015Polyradiculopathy (PRP) is a rare but serious neurologic complication of cytomegalovirus (CMV) in patients with acquired immunodeficiency syndrome (AIDS). We herein...
Polyradiculopathy (PRP) is a rare but serious neurologic complication of cytomegalovirus (CMV) in patients with acquired immunodeficiency syndrome (AIDS). We herein report three cases of CMV PRP in patients with AIDS. Although providing a prompt diagnosis and initiating anti-CMV therapy may achieve clinical improvements, administering single-drug treatment may result in virologic failure. Therefore, introducing antiretroviral therapy is a key step for improving the treatment outcomes of CMV PRP.
Topics: Acquired Immunodeficiency Syndrome; Adult; Antiviral Agents; Asian People; Cerebrospinal Fluid; Cytomegalovirus Infections; Humans; Male; Middle Aged; Polyradiculopathy
PubMed: 25758080
DOI: 10.2169/internalmedicine.54.2438 -
Continuum (Minneapolis, Minn.) Feb 2021Cauda equina dysfunction (often referred to as cauda equina syndrome) is caused by a diverse group of disorders that affect the lumbosacral nerve roots. It is important... (Review)
Review
PURPOSE OF REVIEW
Cauda equina dysfunction (often referred to as cauda equina syndrome) is caused by a diverse group of disorders that affect the lumbosacral nerve roots. It is important to recognize dysfunction of the cauda equina quickly to minimize diagnostic delay and lasting neurologic symptoms. This article describes cauda equina anatomy and the clinical features, differential diagnosis, and management of cauda equina disorders.
RECENT FINDINGS
The diagnosis of disorders of the cauda equina continues to be a challenge. If a compressive etiology is seen, urgent neurosurgical intervention is recommended. However, many people with clinical features of cauda equina dysfunction will have negative diagnostic studies. If the MRI is negative, it is important to understand the diagnostic evaluation and differential diagnosis so that less common etiologies are not missed.
SUMMARY
Cauda equina dysfunction most often occurs due to lumbosacral disk herniation. Nondiskogenic causes include vascular, infectious, inflammatory, traumatic, and neoplastic etiologies. Urgent evaluation and surgical intervention are recommended in most cases of compressive cauda equina syndrome. Other types of treatment may also be indicated depending on the etiology.
Topics: Cauda Equina; Delayed Diagnosis; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Polyradiculopathy
PubMed: 33522743
DOI: 10.1212/CON.0000000000000903 -
Continuum (Minneapolis, Minn.) Apr 2018Conditions that affect the cauda equina are a diverse group of disorders that require timely recognition and management. This article reviews cauda equina anatomy, the... (Review)
Review
PURPOSE OF REVIEW
Conditions that affect the cauda equina are a diverse group of disorders that require timely recognition and management. This article reviews cauda equina anatomy, the diagnostic approach to disorders of the cauda equina, features of cauda equina syndrome, and diskogenic and nondiskogenic disorders of the cauda equina.
RECENT FINDINGS
Establishing clinical criteria for cauda equina syndrome has been a focus of a number of reviews, although the clinician must maintain a low threshold for emergent imaging in cases of suspected cauda equina syndrome because of the suboptimal reliability of various signs and symptoms in identifying this condition clinically. The timing of surgical intervention for compressive causes of cauda equina dysfunction remains a point of contention, although urgent decompression remains standard practice. A recent review that focused on outcomes in patients with cauda equina compression who underwent surgical decompression identified significant residual deficits in patients despite appropriate and timely intervention. Autoimmune conditions targeting the cauda equina have been increasingly recognized, including chronic immune sensory polyradiculopathy and chronic immune sensorimotor polyradiculopathy.
SUMMARY
Disorders that affect the cauda equina require thoughtful and timely clinical examination and diagnostic testing to establish a definitive cause and an appropriate treatment approach.
Topics: Autoimmune Diseases; Cauda Equina; Decompression; Humans; Polyradiculopathy; Time Factors
PubMed: 29613901
DOI: 10.1212/CON.0000000000000584