Ingrid Hoeritzauer1,2,3, Alan Carson4,2,5, Patrick Statham2,6,3, Jalesh N Panicker7, Voula Granitsiotis8, Maria Eugenicos9, David Summers10, Andreas K Demetriades4,2,6,3, Jon Stone4,2. 1. Centre for Clinical Brain Sciences, University of Edinburgh, UK Ingrid.hoeritzauer@ed.ac.uk. 2. Department of Clinical Neurosciences, Western General Hospital, UK. 3. Edinburgh Spinal Surgery Outcomes Study Group. 4. Centre for Clinical Brain Sciences, University of Edinburgh, UK. 5. Department of Rehabilitation Medicine, NHS Lothian, Edinburgh, UK. 6. Department of Neurosurgery, Western General Hospital, UK. 7. Department of Uro-Neurology, The National Hospital of Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London UK. 8. Department of Urology, Western General Hospital, Edinburgh UK. 9. Department of Gastroenterology, Western General Hospital, Edinburgh, UK. 10. Department of Neuroradiology, Western General Hospital, Edinburgh UK.
Abstract
OBJECTIVE: To describe clinical features relevant to diagnosis, mechanism and aetiology in patients with 'scan-negative' cauda equina syndrome (CES). METHODS: We carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery centre comprising semi-structured interview and questionnaires investigating presenting symptoms, neurological examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress and disability. RESULTS: 198 patients presented consecutively over 28 months. 47 were diagnosed with 'scan-positive' CES (mean age 48yrs, 43% female). 76 'mixed' category patients had nerve root compression/displacement without CES compression, (mean age 46yrs, 71% female) and 61 patients had 'scan-negative' CES (mean age 40yrs, 77% female). An alternative neurological cause of CES emerged in 14/198 patients during admission and 4/151 patients with mean duration 25 months follow up.Patients with 'scan-negative' CES had more positive clinical signs of a functional neurological disorder (11%'scan positive' CES v. 34%mixed and 68%'scan-negative', p<0.0001), were more likely to describe their current back pain as 'worst ever' (41% vs. 46% and 70%, p=0.005) and have symptoms of a panic attack at onset (37% vs. 57% and 70%, p=0.001). Patients with 'scan positive' CES were more likely to have reduced/absent bilateral ankle jerks (78% 'vs. 30% and 12%, p=<0.0001). There was no significant difference between groups in the frequency of reduced anal tone and urinary retention. CONCLUSIONS: The first well phenotyped, prospective study of 'scan-negative' CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurological disorder may be relevant.
OBJECTIVE: To describe clinical features relevant to diagnosis, mechanism and aetiology in patients with 'scan-negative' cauda equina syndrome (CES). METHODS: We carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery centre comprising semi-structured interview and questionnaires investigating presenting symptoms, neurological examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress and disability. RESULTS: 198 patients presented consecutively over 28 months. 47 were diagnosed with 'scan-positive' CES (mean age 48yrs, 43% female). 76 'mixed' category patients had nerve root compression/displacement without CES compression, (mean age 46yrs, 71% female) and 61 patients had 'scan-negative' CES (mean age 40yrs, 77% female). An alternative neurological cause of CES emerged in 14/198 patients during admission and 4/151 patients with mean duration 25 months follow up.Patients with 'scan-negative' CES had more positive clinical signs of a functional neurological disorder (11%'scan positive' CES v. 34%mixed and 68%'scan-negative', p<0.0001), were more likely to describe their current back pain as 'worst ever' (41% vs. 46% and 70%, p=0.005) and have symptoms of a panic attack at onset (37% vs. 57% and 70%, p=0.001). Patients with 'scan positive' CES were more likely to have reduced/absent bilateral ankle jerks (78% 'vs. 30% and 12%, p=<0.0001). There was no significant difference between groups in the frequency of reduced anal tone and urinary retention. CONCLUSIONS: The first well phenotyped, prospective study of 'scan-negative' CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurological disorder may be relevant.