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Andreas K Demetriades - One of the best experts on this subject based on the ideXlab platform.
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acute bilateral foot drop with or without Cauda Equina Syndrome a case series
Acta Neurochirurgica, 2021Co-Authors: Andreas K Demetriades, Marco Mancusomarcello, Asfand Baig Mirza, Joseph Frantzias, David A Bell, Richard Selway, Richard GullanAbstract:Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma and relevant systemic illness excluded. Methods Data from three different centres had been collected at the time of historic treatment, and records were subsequently reviewed retrospectively, documenting the clinical presentation, radiological level of compression, timing of surgery, and degree of neurological recovery. Results Seven patients are presented. The mean age at presentation was 52.1 years (range 41-66). All patients but one were male. All had a painful radiculopathic presentation. Relevant discopathy was observed from L2/3 to L5/S1, the commonest level being L3/4. Five were treated within 24 h of presentation, and two within 48 h. Three had concomitant Cauda Equina Syndrome; of these, the first two made a full motor recovery, one by 6 weeks follow-up and the second on the same-day post-op evaluation. Overall, five out of seven cases had full resolution of their ankle dorsiflexion pareses. One patient with 1/5 power has not improved. Another with 1/5 weakness improved to normal on the one side and to 3/5 on the other. Conclusion When bilateral foot drop occurs acutely, we encourage the consideration of degenerative spinal disease. Relevant discopathy was observed from L2/3 to L5/S1; aberrant innervation may be at play. Cauda Equina Syndrome is not necessarily associated with acute bilateral foot drop. The prognosis seems to be pretty good with respect to recovery of the foot drop, especially if partial at presentation and if treated within 48 h.
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acute bilateral foot drop with or without Cauda Equina Syndrome a case series
Acta Neurochirurgica, 2021Co-Authors: Andreas K Demetriades, Marco Mancusomarcello, Asfand Baig Mirza, Joseph Frantzias, David A Bell, Richard Selway, Richard GullanAbstract:Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma and relevant systemic illness excluded. Data from three different centres had been collected at the time of historic treatment, and records were subsequently reviewed retrospectively, documenting the clinical presentation, radiological level of compression, timing of surgery, and degree of neurological recovery. Seven patients are presented. The mean age at presentation was 52.1 years (range 41–66). All patients but one were male. All had a painful radiculopathic presentation. Relevant discopathy was observed from L2/3 to L5/S1, the commonest level being L3/4. Five were treated within 24 h of presentation, and two within 48 h. Three had concomitant Cauda Equina Syndrome; of these, the first two made a full motor recovery, one by 6 weeks follow-up and the second on the same-day post-op evaluation. Overall, five out of seven cases had full resolution of their ankle dorsiflexion pareses. One patient with 1/5 power has not improved. Another with 1/5 weakness improved to normal on the one side and to 3/5 on the other. When bilateral foot drop occurs acutely, we encourage the consideration of degenerative spinal disease. Relevant discopathy was observed from L2/3 to L5/S1; aberrant innervation may be at play. Cauda Equina Syndrome is not necessarily associated with acute bilateral foot drop. The prognosis seems to be pretty good with respect to recovery of the foot drop, especially if partial at presentation and if treated within 48 h.
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scan negative Cauda Equina Syndrome a prospective cohort study
Neurology, 2021Co-Authors: Ingrid Hoeritzauer, Alan Carson, Patrick Statham, Andreas K Demetriades, Jalesh N Panicker, Voula Granitsiotis, Maria Eugenicos, David S Summers, Jon StoneAbstract:Objective To describe clinical features relevant to diagnosis, mechanism, and etiology 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 center comprising semi-structured interview and questionnaires investigating presenting symptoms, neurologic examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress, and disability. Results A total of 198 patients presented consecutively over 28 months. A total of 47 were diagnosed with scan-positive CES (mean age 48 years, 43% female). A total of 76 mixed category patients had nerve root compression/displacement without CES compression (mean age 46 years, 71% female) and 61 patients had scan-negative CES (mean age 40 years, 77% female). An alternative neurologic 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 neurologic disorder (11% scan-positive CES vs 34% mixed and 68% scan-negative, p Conclusion The first well-phenotyped, prospective study of scan-negative CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurologic disorders may be relevant.
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are we neglecting sexual function assessment in suspected Cauda Equina Syndrome
Surgeon-journal of The Royal Colleges of Surgeons of Edinburgh and Ireland, 2020Co-Authors: Savva Pronin, Ingrid Hoeritzauer, Patrick Statham, Andreas K DemetriadesAbstract:Abstract Objectives We assessed the documentation rates of signs and symptoms, including sexual function, in patients with suspected Cauda Equina Syndrome and whether they can be improved by increasing local awareness. Patients and methods We reviewed all electronic records of patients referred with suspected CES who required urgent MRI to our regional service over a 2 month period. We recorded the documentation rates of clinical signs and symptoms. The results were presented locally to increase awareness. A further 2 month period was then re-audited. 120 patients in total were included across both time periods. Chi-squared was used to compare documentation rates between time periods. Results 25 of 120 patients had radiological Cauda Equina compression. Lower limb neurology, urinary function and saddle sensation were almost universally documented. After the intervention, there was a significant increase (p Conclusion Certain clinical features of CES are well documented. Increasing awareness may improve documentation of certain symptoms/signs in patients with suspected Cauda Equina Syndrome. Sexual function was poorly documented and increasing awareness alone is an inadequate intervention.
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the clinical features and outcome of scan negative and scan positive cases in suspected Cauda Equina Syndrome a retrospective study of 276 patients
Journal of Neurology, 2018Co-Authors: Ingrid Hoeritzauer, Alan Carson, Savva Pronin, Patrick Statham, Andreas K Demetriades, Jon StoneAbstract:Background The majority of patients presenting with suspected clinical Cauda Equina Syndrome (CES) have no identifiable structural cause for their symptoms (‘scan-negative’ CES). Understanding these patients aids clinical differentiation and management in CES.
Ingrid Hoeritzauer - One of the best experts on this subject based on the ideXlab platform.
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scan negative Cauda Equina Syndrome what to do when there is no neurosurgical cause
Practical Neurology, 2021Co-Authors: Ingrid Hoeritzauer, Biba R Stanton, Alan Carson, Jon StoneAbstract:Suspected Cauda Equina Syndrome is a common presentation in emergency departments, but most patients (≥70%) have no Cauda Equina compression on imaging. As neurologists become more involved with 'front door' neurology, referral rates of patients with these symptoms are increasing. A small proportion of patients without structural pathology have other neurological causes: we discuss the differential diagnosis and how to recognise these. New data on the clinical features of patients with 'scan-negative' Cauda Equina Syndrome suggest that the symptoms are usually triggered by acute pain (with or without root impingement) causing changes in brain-bladder feedback in vulnerable individuals, exacerbated by medication and anxiety, and commonly presenting with features of functional neurological disorder.
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scan negative Cauda Equina Syndrome a prospective cohort study
Neurology, 2021Co-Authors: Ingrid Hoeritzauer, Alan Carson, Patrick Statham, Andreas K Demetriades, Jalesh N Panicker, Voula Granitsiotis, Maria Eugenicos, David S Summers, Jon StoneAbstract:Objective To describe clinical features relevant to diagnosis, mechanism, and etiology 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 center comprising semi-structured interview and questionnaires investigating presenting symptoms, neurologic examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress, and disability. Results A total of 198 patients presented consecutively over 28 months. A total of 47 were diagnosed with scan-positive CES (mean age 48 years, 43% female). A total of 76 mixed category patients had nerve root compression/displacement without CES compression (mean age 46 years, 71% female) and 61 patients had scan-negative CES (mean age 40 years, 77% female). An alternative neurologic 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 neurologic disorder (11% scan-positive CES vs 34% mixed and 68% scan-negative, p Conclusion The first well-phenotyped, prospective study of scan-negative CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurologic disorders may be relevant.
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are we neglecting sexual function assessment in suspected Cauda Equina Syndrome
Surgeon-journal of The Royal Colleges of Surgeons of Edinburgh and Ireland, 2020Co-Authors: Savva Pronin, Ingrid Hoeritzauer, Patrick Statham, Andreas K DemetriadesAbstract:Abstract Objectives We assessed the documentation rates of signs and symptoms, including sexual function, in patients with suspected Cauda Equina Syndrome and whether they can be improved by increasing local awareness. Patients and methods We reviewed all electronic records of patients referred with suspected CES who required urgent MRI to our regional service over a 2 month period. We recorded the documentation rates of clinical signs and symptoms. The results were presented locally to increase awareness. A further 2 month period was then re-audited. 120 patients in total were included across both time periods. Chi-squared was used to compare documentation rates between time periods. Results 25 of 120 patients had radiological Cauda Equina compression. Lower limb neurology, urinary function and saddle sensation were almost universally documented. After the intervention, there was a significant increase (p Conclusion Certain clinical features of CES are well documented. Increasing awareness may improve documentation of certain symptoms/signs in patients with suspected Cauda Equina Syndrome. Sexual function was poorly documented and increasing awareness alone is an inadequate intervention.
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evaluation of nationwide referral pathways investigation and treatment of suspected Cauda Equina Syndrome in the united kingdom
British Journal of Neurosurgery, 2019Co-Authors: Daniel M Fountain, Ingrid Hoeritzauer, Simon Davies, Julie Woodfield, Mohammed Kamel, Paulina Majewska, Ellie Edlmann, Aimun A B Jamjoom, Mueez Waqar, Dominic E MahoneyAbstract:Purpose: Cauda Equina Syndrome (CES) is a spinal emergency with clinical symptoms and signs that have low diagnostic accuracy. National guidelines in the United Kingdom (UK) state that all patients...
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understanding Cauda Equina Syndrome protocol for a uk multicentre prospective observational cohort study
BMJ Open, 2018Co-Authors: Nisaharan Srikandarajah, Ingrid Hoeritzauer, Savva Pronin, Julie Woodfield, Aimun A B Jamjoom, Michael Poon, Holly RoyAbstract:Introduction Cauda Equina Syndrome (CES) is a potentially devastating condition caused by compression of the Cauda Equina nerve roots. This can result in bowel, bladder and sexual dysfunction plus lower limb weakness, numbness and pain. CES occurs infrequently, but has serious potential morbidity and medicolegal consequences. This study aims to identify and describe the presentation and management of patients with CES in the UK. Methods and analysis Understanding Cauda Equina Syndrome (UCES) is a prospective and collaborative multicentre cohort study of adult patients with confirmed CES managed at specialist spinal centres in the UK. Participants will be identified using neurosurgical and orthopaedic trainee networks to screen referrals to spinal centres. Details of presentation, investigations, management and service usage will be recorded. Both patient-reported and clinician-reported outcome measures will be assessed for 1 year after surgery. This will establish the incidence of CES, current investigation and management practices, and adherence to national standards of care. Outcomes will be stratified by clinical presentation and patient management. Accurate and up to date information about the presentation, management and outcome of patients with CES will inform standards of service design and delivery for this important but infrequent condition. Ethics and dissemination UCES received a favourable ethical opinion from the South East Scotland Research Ethics Committee 02 (Reference: 18/SS/0047; IRAS ID: 233515). All spinal centres managing patients with CES in the UK will be encouraged to participate in UCES. Study results will be published in medical journals and shared with local participating sites. Trial registration number ISRCTN16828522; Pre-results.
Jon Stone - One of the best experts on this subject based on the ideXlab platform.
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scan negative Cauda Equina Syndrome what to do when there is no neurosurgical cause
Practical Neurology, 2021Co-Authors: Ingrid Hoeritzauer, Biba R Stanton, Alan Carson, Jon StoneAbstract:Suspected Cauda Equina Syndrome is a common presentation in emergency departments, but most patients (≥70%) have no Cauda Equina compression on imaging. As neurologists become more involved with 'front door' neurology, referral rates of patients with these symptoms are increasing. A small proportion of patients without structural pathology have other neurological causes: we discuss the differential diagnosis and how to recognise these. New data on the clinical features of patients with 'scan-negative' Cauda Equina Syndrome suggest that the symptoms are usually triggered by acute pain (with or without root impingement) causing changes in brain-bladder feedback in vulnerable individuals, exacerbated by medication and anxiety, and commonly presenting with features of functional neurological disorder.
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scan negative Cauda Equina Syndrome a prospective cohort study
Neurology, 2021Co-Authors: Ingrid Hoeritzauer, Alan Carson, Patrick Statham, Andreas K Demetriades, Jalesh N Panicker, Voula Granitsiotis, Maria Eugenicos, David S Summers, Jon StoneAbstract:Objective To describe clinical features relevant to diagnosis, mechanism, and etiology 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 center comprising semi-structured interview and questionnaires investigating presenting symptoms, neurologic examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress, and disability. Results A total of 198 patients presented consecutively over 28 months. A total of 47 were diagnosed with scan-positive CES (mean age 48 years, 43% female). A total of 76 mixed category patients had nerve root compression/displacement without CES compression (mean age 46 years, 71% female) and 61 patients had scan-negative CES (mean age 40 years, 77% female). An alternative neurologic 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 neurologic disorder (11% scan-positive CES vs 34% mixed and 68% scan-negative, p Conclusion The first well-phenotyped, prospective study of scan-negative CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurologic disorders may be relevant.
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the clinical features and outcome of scan negative and scan positive cases in suspected Cauda Equina Syndrome a retrospective study of 276 patients
Journal of Neurology, 2018Co-Authors: Ingrid Hoeritzauer, Alan Carson, Savva Pronin, Patrick Statham, Andreas K Demetriades, Jon StoneAbstract:Background The majority of patients presenting with suspected clinical Cauda Equina Syndrome (CES) have no identifiable structural cause for their symptoms (‘scan-negative’ CES). Understanding these patients aids clinical differentiation and management in CES.
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Cauda Equina Syndrome with normal MR imaging
Journal of Neurology, 2009Co-Authors: Alasdair Rooney, Patrick F. Statham, Jon StoneAbstract:The aim of this study was to compare the clinical characteristics of patients with and without abnormal MR imaging admitted to a neurosurgical unit with suspected Cauda Equina Syndrome using a retrospective study of consecutive admissions to a regional neurosurgical unit over a 10-month period. Clinical details were obtained from the case notes. A lumbar spine MR scan to investigate possible Cauda Equina Syndrome was performed in 66 patients. There were no significant differences between those with abnormal imaging ( n = 34, 52%) and those with a normal scan ( n = 32, 48%) in respect of sex, clinical history or features recorded on examination. Those with normal imaging had a high frequency of weakness ( n = 18, 59%), saddle numbness ( n = 17, 57%), leg numbness ( n = 24, 80%), urinary incontinence ( n = 13, 54%) and urinary retention ( n = 9, 53%). A large number of patients present to neurosurgical units with symptoms suggestive of Cauda Equina Syndrome without any radiological evidence of structural pathology. While some may have had an alternative organic cause, we propose that these symptoms may have a “functional” origin in many patients.
Scott Shapiro - One of the best experts on this subject based on the ideXlab platform.
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medical realities of Cauda Equina Syndrome secondary to lumbar disc herniation
Spine, 2000Co-Authors: Scott ShapiroAbstract:Study Design.An analysis of 44 Cauda Equina Syndrome cases.Objectives.To determine the neurologic outcome of Cauda Equina Syndrome cases, in light of the significant medical implications of this disorder.Summary of Background Data.Cauda Equina Syndrome from lumbar disc herniation accounts for up to
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Cauda Equina Syndrome secondary to lumbar disc herniation
Neurosurgery, 1994Co-Authors: Scott ShapiroAbstract:Between 1986 and 1991, 14 patients (nine men and five women), ranging in age from 22 to 67 years (mean, 43 yr), presented with acute Cauda Equina Syndrome from a herniated lumbar disc. All presented with bilateral sciatica and leg weakness; 13 (93%) had urine or stool incontinence, or both. At presentation, all were emergently studied with myelogram/computed tomographic or magnetic resonance imaging. Nine (64%) had large or massive herniations, including two with tethered cords. Five had smaller herniations superimposed on preexisting stenosis. Three had previous surgery; two-thirds had a herniation at a different level. The levels of the herniations were L4-L5 in nine patients, L5-S1 in three patients, and L3-L4 in two patients. The time to surgery ranged from less than 24 hours to more than 30 days; 11 patients underwent surgery within 5 days of onset. Follow-up ranged from 6 months to 5 years (mean, 3.3 yr). Postoperatively, six patients (44%) were normal, four (28%) had chronic pain and numbness, and four (28%) had persistent incontinence and weakness. All the patients were ambulatory. There were no operative deaths, and only one patient had a wound infection. Of the 10 patients who had no incontinence after surgery, 7 underwent surgery within 48 hours of onset. Of the four patients with persistent incontinence, all underwent surgery after 48 hours. Previous reports and our experience demonstrate the following most common characteristics for this presentation: 1) male sex; 2) L4-L5 herniations; and 3) onset in the 4th decade.(ABSTRACT TRUNCATED AT 250 WORDS)
G R Cosgrove - One of the best experts on this subject based on the ideXlab platform.
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hemorrhage into a lumbar synovial cyst causing an acute Cauda Equina Syndrome case report
Journal of Neurosurgery, 1994Co-Authors: Stephen B Tatter, G R CosgroveAbstract:✓ Juxtafacet cysts of the lumbar spine have been reported with increasing frequency but their pathogenesis remains obscure. These cysts most frequently present with back pain, followed by chronic progressive radiculopathy or gradual onset of symptoms of spinal canal compromise. The authors report an unusual case of hemorrhage into a right L3–4 synovial cyst causing an acute Cauda Equina Syndrome and describe its successful surgical treatment. The clinical, radiographic, and pathological features are discussed.