Transient cauda equina syndrome related to a sacral schwannoma with cauda equine compression after a lumbar epidural block -A case report-.
Abstract: A 53-year-old man had chronic low back and leg pain for four years without any history of trauma or neurological manifestations. There was a reduction in symptoms after a lumbar epidural block. Two hours later after the procedure, the patient complained of perineal numbness and lower extremity weakness. The neurological evaluation revealed loss of sensation in the saddle area and the posterior aspect of the leg. The deep-tendon reflexes were decreased in the leg. The patient was unable to urinate. The MRI revealed a schwannoma at the S3 level of the sacral spine with cauda equina compression. The patient's symptoms improved slightly over the next few hours. The patient had a gradual return of motor function and could feel the Foley catheter. All of the symptoms completely resolved over the next nine hours and the patient was discharged to home once completely recovered. This case illustrates the importance of clinical examination and continued vigilance for evaluation of neurological deterioration after epidural injections.
Publication Date: 2010-12-31 PubMed ID: 21286446PubMed Central: PMC3030042DOI: 10.4097/kjae.2010.59.S.S222Google Scholar: Lookup
The Equine Research Bank provides access to a large database of publicly available scientific literature. Inclusion in the Research Bank does not imply endorsement of study methods or findings by Mad Barn.
- Journal Article
- Case Reports
- Clinical Examination
- Clinical Findings
- Clinical Signs
- Clinical Study
- Clinical Symptoms
- Diagnosis
- Diagnostic Imaging
- Diagnostic Technique
- Disease Diagnosis
- Disease Treatment
- Epidural
- Magnetic Resonance Imaging
- Nervous System
- Neurological Diseases
- Neurology
- Pain Management
- Spine
- Vertebrae
- Veterinary Practice
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The research discusses a unique instance in which a 53-year-old patient, who suffered from chronic lower back pain and leg pain, experienced a temporary neural disorder known as transient cauda equina syndrome, after a lumbar epidural block procedure. This was found to be linked to a schwannoma at the S3 level of his sacral spine, which was compressing the cauda equina.
Epidural Block and its Aftermath
- The research starts with describing the initial condition of a 53-year-old man who had been suffering from chronic low back and leg pain for four years. He had no history of any trauma or neurological issues.
- He undergone a lumbar epidural block procedure in hopes of pain relief – the result was positive and there was a noted reduction in his symptoms.
- However, a few hours post-procedure the patient started experiencing perineal numbness and weakness in the lower extremities. His neurological evaluation revealed loss of sensation in the saddle area and the back of his leg. Furthermore, he was unable to pass urine.
Diagnosis and Recovery
- The patient was immediately given an MRI, which revealed a schwannoma at the S3 level of his sacral spine, which was causing compression to the cauda equina. The cauda equina is a bundle of spinal nerves and nerve roots. The compression of this nerve bundle can lead to severe neurological issues.
- The symptoms of numbness and weakness improved slightly over the next few hours and the patient also gradually regained his motor functions.
- Remarkably, all symptoms completely disappeared over the next nine hours and the patient was given clearance to return home.
Lesson from the Case
- This case draws attention to the importance of continual monitoring for potential neurological deterioration post epidural injections. Despite not being common, there can be complications and potential medical emergencies tied to this procedure.
- Moreover, it is crucial to conduct attentive clinical examinations as they can be effective in determining the presence of conditions that may not immediately apparent, such as a schwannoma.
Cite This Article
APA
Kim HT, Gim TJ, Lee JH.
(2010).
Transient cauda equina syndrome related to a sacral schwannoma with cauda equine compression after a lumbar epidural block -A case report-.
Korean J Anesthesiol, 59 Suppl(Suppl), S222-S225.
https://doi.org/10.4097/kjae.2010.59.S.S222 Publication
Researcher Affiliations
- Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea.
References
This article includes 14 references
- Vad VB, Bhat AL, Lutz GE, Cammisa F. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study.. Spine 2002;27:11–16.
- Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain.. Orthop Clin North Am 1991;22:263–271.
- Alter M. Statistical aspect of spinal cord tumors.. Handbook of Clinical Neurology 1975. pp. 1–22.
- De Verdelhan O, Haegelen C, Carsin-Nicol B, Riffaud L, Amlashi SF, Brassier G. MR imaging features of spinal schwannomas and meningiomas.. J Neuroradiol 2005;32:42–49.
- Celli P, Trillò G, Ferrante L. Spinal extradural schwannoma.. J Neurosurg Spine 2005;2:447–456.
- Seppälä MT, Haltia MJ, Sankila RJ, Jääskeläinen JE, Heiskanen O. Long-term outcome after removal of spinal schwannoma: a clinicopathological study of 187 cases.. J Neurosurg 1995;83:621–626.
- Chen CP, Tang SF, Hsu TC, Tsai WC, Liu HP, Chen MJ. Ultrasound guidance in caudal epidural needle placement.. Anesthesiology 2004;101:181–184.
- Carette S, Leclaire R, Marcoux S, Morin F, Blaise GA, St-Pierre A. Epidural corticosteroid injections for sciatica due to herniated nucleus pulposus.. N Engl J Med 1997;336:1634–1640.
- White AH, Derby R, Wynne G. Epidural injections for the diagnosis and treatment of low back pain.. Spine 1980;5:78–86.
- Usubiaga JE, Usubiaga LE, Brea LM, Goyena R. Effect of saline injection on epidural and subarachnoid space pressures and relation to postspinal anesthesia headache.. Anesth Analg 1967;46:293–296.
- McLain RF, Fry M, Hecht ST. Transient paralysis associated with epidural steroid injection.. J Spinal Disord 1997;10:441–444.
- Chaudhari LS, Kop BR, Dhruva AJ. Paraplegia and epidural analgesia.. Anaesthesia 1978;33:722–725.
- Kwon MA, Park JH, Yoo RG, Kim TH, Sim WS. Benign and malignant tumors detected in the patients with intractable chest pain: 2 case reports.. Korean J Pain 2005;18:255–258.
- Lee HK, Shin DY, Lee HJ, Kim C. Intercostal neuralgia and spinal cord compression symptom due to spinal tumor: a case report.. J Korean Pain Soc 1994;7:287–291.
Use Nutrition Calculator
Check if your horse's diet meets their nutrition requirements with our easy-to-use tool Check your horse's diet with our easy-to-use tool
Talk to a Nutritionist
Discuss your horse's feeding plan with our experts over a free phone consultation Discuss your horse's diet over a phone consultation
Submit Diet Evaluation
Get a customized feeding plan for your horse formulated by our equine nutritionists Get a custom feeding plan formulated by our nutritionists
