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An Unusual Radiologic Appearance of Disc Extrusion Causing Cauda Equina Syndrome 1 Joseph R. Grajo, M.D., 2 Shamima Y. Ahmed, B.S., 1 Natasa Dragicevic , M.D., Ph.D , 3 Thora S teffensen , M.D ., 1 Robert A. Zamore , M.D.
An Unusual Radiologic Appearance of Disc Extrusion Causing CaudaEquina Syndrome
1) Discuss the incidence and pathophysiology of caudaequina syndrome.
2) Review an unusual presentation of caudaequina syndrome.
3) Highlight the role of imaging modalities in diagnosis of this neurological emergency.
Caudaequina syndrome (CES) is a well-known neurological disease caused by compression of the lumbosacral nerve roots. Caudaequina syndrome remains extremely rare as a complicating condition of intervertebraldisc herniation and spinal stenosis. This case is unique due to the fact that this patient had severe spinal stenosis with saddle hypoparesthesia, paraparesis and caudaequinasyndrome. The patient gradually developed pain and disability after minor stress to his spinal column. Other factors, which may have aggravated the condition and precipitated the herniation, include obesity and osteoporosis,
MethodsWe will discuss the utility of magnetic resonance Imaging (MRI)in the diagnosis of caudaequina syndrome. Our case includes discussion of the patient’s history and unique radiologic findings
ResultsRadiologic findings of caudaequina syndrome will be presented.
ConclusionThe diagnosis and management of caudaequina syndrome is critically dependent on imaging along with history and physical exam. MRI is the modality of choice in evaluating patients with suspected CES.
Imaging Modalities & Management
Figure 2. Axial (a) and sagittal (b) T2-weighted images show the extraduralmass to be heterogeneous and isointense to the disc. Again, it causes severe central canal stenosis and compression of the caudaequina.
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Figure 3. Axial (a) and sagittal (b) post-contrast T1-weighted images demonstrate peripheral enhancement of the lesion following gadolinium administration, typical of a herniated disc
Figure 4. Fibrocartilage with clustering of chondrocytes, indicated by the arrow. At the lower edge of the image, a focus of neovascularization is seen, considered to correlate with disc prolapse.