Neurogenic bladder is a common cause of acute pyelonephritis (APN) in cauda equina syndrome (CES). Perirenal hemorrhage, a rare complication of APN, can be a life-threatening condition. To our knowledge, there is no previous report of perirenal hemorrhage as a complication of APN in CES. A 57-year-old male, diagnosed with CES, due to a L3 burst fracture 3 months earlier, was presented with fever and chills. His diagnosis was APN due to neurogenic bladder. After treatment for APN, he was transferred to the department of rehabilitation medicine for management of his CES. Because of large post-voiding residual urine volumes, he performed self-catheterization after voiding. However, he presented again with fever and chills, and recurrent APN was diagnosed. On the third day of antibiotic treatment, he had acute abdominal pains and hypovolemic shock. Abdominal computed tomography and angiography showed left APN and a perirenal hematoma with left renal capsular artery bleeding. After embolization of the left renal capsular artery, no further active bleeding occurred. Because APN due to neurogenic bladder can lead to critical complications, such as perirenal hemorrhage, the physician should pay attention to the early diagnosis and treatment of urinary tract infection and the management of neurogenic bladder after CES.
The intrathecal chemotherapy with methotrexate and cytarabine arabinoside is used for the treatment and prophylaxis of the primary central nervous system lymphoma. The therapy may induce neurotoxicity including the cauda equina syndrome. We report a case of a 58-year-old man with the diffuse large B-cell lymphoma, who developed the cauda equina syndrome after the administration of intrathecal methotrexate and cytarabine arabinoside, as diagnosed by the electrodiagnostic, urodynamic, and radiologic approaches.
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Spinal dural arteriovenous fistula (SDAVF) is rare but still the most commonly encountered vascular malformation of the spinal cord. A 31-year-old male developed gait disturbance due to weakness of his lower extremities, voiding difficulty and sexual dysfunction with a progressive course since 3 months. He showed areflexia in both knees and ankles. Electromyographic findings were suggestive of multiple root lesions involving bilateral L2 to S4 roots of moderate degree. Magnetic resonance images showed high signal intensity with an ill-defined margin in T2-weighted images and intensely enhanced by a contrast agent through the lumbosacral spinal cord. Selective spinal angiography confirmed a dural arteriovenous fistula with a nidus at the L2 vertebral level. After selective endovascular embolization, his symptoms drastically improved except sexual dysfunction. We report a rare case of cauda equina syndrome due to spinal arteriovenous fistula with drastic improvement after endovascular embolization.
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Achondroplasia is a congenital developmental condition characterized pathologically by defective enchondral ossification, affecting chiefly the long bones, and clinically by peculiar dwarfism with short extremities and normal trunk. One of the most common neurologic manifestation in achondroplastic patients in adulthood is spinal stenosis where the prominent characteristics of lumbar vertebrae structure are shortening of interpedicular distance and hypertrophy of vertebral pedicle. There has been no case report of traumatic cauda equina syndrome resulted in paraparesis among achondroplasic patients in Korea. We experienced a 30 year-old achondroplastic man sustained paraparesis as the result of an accidental slipping down. After the surgical decompression, the patient made slow recovery in all aspects of function via rehabilitation therapy.
Spinal manipulative therapy is frequently prescribed for back and neck pain. Though most persons practicing manipulation insist that spinal manipulative therapy is a safe treatment, serious complications could occur. It is essential to be aware of these complications in prescribing or practicing prreting manipulative therapy. We report one case of cauda equina syndrome caused by spinal manipulative therapy with review of literatures.
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