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Brian G Weinshenker - One of the best experts on this subject based on the ideXlab platform.
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elsberg syndrome a rarely recognized cause of cauda equina syndrome and lower thoracic myelitis
Neuroimmunology and Neuroinflammation, 2017Co-Authors: Filippo Savoldi, Timothy J Kaufmann, Eoin P Flanagan, Michel Toledano, Brian G WeinshenkerAbstract:OBJECTIVE Elsberg syndrome (ES) is an established but often unrecognized cause of acute lumbosacral radiculitis with myelitis related to recent herpes virus infection. We defined ES, determined its frequency in patients with cauda equina syndrome (CES) with myelitis, and evaluated its clinical, radiologic, and microbiologic features and outcomes. METHODS We searched the Mayo Clinic medical records for ES and subsequently for combinations of index terms to identify patients with suspected CES and myelitis. RESULTS Our search yielded 30 patients, 2 diagnosed with ES and an additional 28 with clinical or radiologic evidence of CES retrospectively suspected of having ES. We classified patients in 5 groups according to diagnostic certainty. MRI and EMG confirmed that 2 had only myelitis, 5 only radiculitis, and 16 both. Two had preceding sacral herpes infection and 1 oral herpes simplex. Spinal cord lesions were commonly multiple, discontinuous, not expansile, and centrally or ventrally positioned. Lesions generally spared the distal conus. Nerve root enhancement was occasionally prominent and was smooth rather than nodular. Lymphocytic CSF pleocytosis was common. Thirteen patients (43%) had viral isolation studies, which were commonly delayed; the delay may have accounted for the low rate of viral detection. Acyclovir was administered to 6 patients. Most patients recovered with sequelae; 1 patient experienced encephalomyelitis and died. CONCLUSION ES is a definable condition likely responsible for 10% of patients with combined CES and myelitis. Radiologic findings are not entirely specific but may help in differentiating ES from some competing diagnostic considerations. We propose criteria to facilitate diagnosis.
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elsberg syndrome a rarely recognized cause of cauda equina syndrome and lower thoracic myelitis p2 074
Neurology, 2017Co-Authors: Filippo Savoldi, Timothy J Kaufmann, Eoin P Flanagan, Brian G WeinshenkerAbstract:Objective: To define Elsberg syndrome (ES), determine its frequency in patients with cauda equina syndrome (CES) with myelitis and evaluate its clinical, radiologic, microbiologic features and outcomes. Background: When accompanied by myelitis or in the setting of recent herpes virus infection, ES is an established but often unrecognized cause of acute lumbosacral radiculitis. Design/Methods: We searched the Mayo Clinic medical records from 2000 – 2016 for ES and subsequently for combinations of index terms to identify patients with suspected CES and myelitis. Results: Our search yielded 30 patients, 4 diagnosed with ES and an additional 26 patients with retrospectively suspect ES from among 337 patients with CES and suspected myelitis. We classified patients as lab-supported definite (LD, n=3), clinically definite (CD, n=9), probable (CPr, n=10) or possible (CPo, n=8) ES. All had clinically and/or radiologically proven CES. Based on MRI and EMG in 23 patients with adequate data 2 had only myelitis, 5 only radiculitis and 16 both. Two had preceding sacral herpes zoster and 1 oral herpes simplex. Spinal cord lesions were commonly multiple, discontinuous, not expansile, centrally or ventrally positioned and spared the distal conus. Nerve root enhancement was variably prominent, but not nodular. Lymphocytic CSF pleocytosis was common. Although CSF analysis was commonly performed, only thirteen patients (43%) were tested for viral infection; two tested positive for VZV in the CSF, one for HSV2 from a genital swab. Sample acquisition was commonly delayed possibly accounting for the low rate of demonstration of viral infection. Acyclovir was administered to 6 patients. Most patients recovered with sequelae and one patient experienced encephalomyelitis and died. Conclusions: ES is a definable condition likely responsible for 10% of patients with combined CES and myelitis. Radiologic findings are nonspecific but help differentiate ES from competing diagnostic considerations. We propose diagnostic criteria to facilitate diagnosis. Disclosure: Dr. Savoldi has nothing to disclose. Dr. Kaufmann has received personal compensation for activities with T.K. as a consultant. Dr. Flanagan has nothing to disclose. Dr. Weinshenker has received personal compensation for activities with Novartis, Mitsubishi Pharmaceuticals, Medimmune and Alexion Pharmaceuticals. Dr. Weinshenker has received (royalty or license fee or contractual rights) payments from RSR Ltd., Oxford University and MVZ Labor PD and Mayo Foundation.
Filippo Savoldi - One of the best experts on this subject based on the ideXlab platform.
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elsberg syndrome a rarely recognized cause of cauda equina syndrome and lower thoracic myelitis
Neuroimmunology and Neuroinflammation, 2017Co-Authors: Filippo Savoldi, Timothy J Kaufmann, Eoin P Flanagan, Michel Toledano, Brian G WeinshenkerAbstract:OBJECTIVE Elsberg syndrome (ES) is an established but often unrecognized cause of acute lumbosacral radiculitis with myelitis related to recent herpes virus infection. We defined ES, determined its frequency in patients with cauda equina syndrome (CES) with myelitis, and evaluated its clinical, radiologic, and microbiologic features and outcomes. METHODS We searched the Mayo Clinic medical records for ES and subsequently for combinations of index terms to identify patients with suspected CES and myelitis. RESULTS Our search yielded 30 patients, 2 diagnosed with ES and an additional 28 with clinical or radiologic evidence of CES retrospectively suspected of having ES. We classified patients in 5 groups according to diagnostic certainty. MRI and EMG confirmed that 2 had only myelitis, 5 only radiculitis, and 16 both. Two had preceding sacral herpes infection and 1 oral herpes simplex. Spinal cord lesions were commonly multiple, discontinuous, not expansile, and centrally or ventrally positioned. Lesions generally spared the distal conus. Nerve root enhancement was occasionally prominent and was smooth rather than nodular. Lymphocytic CSF pleocytosis was common. Thirteen patients (43%) had viral isolation studies, which were commonly delayed; the delay may have accounted for the low rate of viral detection. Acyclovir was administered to 6 patients. Most patients recovered with sequelae; 1 patient experienced encephalomyelitis and died. CONCLUSION ES is a definable condition likely responsible for 10% of patients with combined CES and myelitis. Radiologic findings are not entirely specific but may help in differentiating ES from some competing diagnostic considerations. We propose criteria to facilitate diagnosis.
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elsberg syndrome a rarely recognized cause of cauda equina syndrome and lower thoracic myelitis p2 074
Neurology, 2017Co-Authors: Filippo Savoldi, Timothy J Kaufmann, Eoin P Flanagan, Brian G WeinshenkerAbstract:Objective: To define Elsberg syndrome (ES), determine its frequency in patients with cauda equina syndrome (CES) with myelitis and evaluate its clinical, radiologic, microbiologic features and outcomes. Background: When accompanied by myelitis or in the setting of recent herpes virus infection, ES is an established but often unrecognized cause of acute lumbosacral radiculitis. Design/Methods: We searched the Mayo Clinic medical records from 2000 – 2016 for ES and subsequently for combinations of index terms to identify patients with suspected CES and myelitis. Results: Our search yielded 30 patients, 4 diagnosed with ES and an additional 26 patients with retrospectively suspect ES from among 337 patients with CES and suspected myelitis. We classified patients as lab-supported definite (LD, n=3), clinically definite (CD, n=9), probable (CPr, n=10) or possible (CPo, n=8) ES. All had clinically and/or radiologically proven CES. Based on MRI and EMG in 23 patients with adequate data 2 had only myelitis, 5 only radiculitis and 16 both. Two had preceding sacral herpes zoster and 1 oral herpes simplex. Spinal cord lesions were commonly multiple, discontinuous, not expansile, centrally or ventrally positioned and spared the distal conus. Nerve root enhancement was variably prominent, but not nodular. Lymphocytic CSF pleocytosis was common. Although CSF analysis was commonly performed, only thirteen patients (43%) were tested for viral infection; two tested positive for VZV in the CSF, one for HSV2 from a genital swab. Sample acquisition was commonly delayed possibly accounting for the low rate of demonstration of viral infection. Acyclovir was administered to 6 patients. Most patients recovered with sequelae and one patient experienced encephalomyelitis and died. Conclusions: ES is a definable condition likely responsible for 10% of patients with combined CES and myelitis. Radiologic findings are nonspecific but help differentiate ES from competing diagnostic considerations. We propose diagnostic criteria to facilitate diagnosis. Disclosure: Dr. Savoldi has nothing to disclose. Dr. Kaufmann has received personal compensation for activities with T.K. as a consultant. Dr. Flanagan has nothing to disclose. Dr. Weinshenker has received personal compensation for activities with Novartis, Mitsubishi Pharmaceuticals, Medimmune and Alexion Pharmaceuticals. Dr. Weinshenker has received (royalty or license fee or contractual rights) payments from RSR Ltd., Oxford University and MVZ Labor PD and Mayo Foundation.
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.
Eoin P Flanagan - One of the best experts on this subject based on the ideXlab platform.
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elsberg syndrome a rarely recognized cause of cauda equina syndrome and lower thoracic myelitis
Neuroimmunology and Neuroinflammation, 2017Co-Authors: Filippo Savoldi, Timothy J Kaufmann, Eoin P Flanagan, Michel Toledano, Brian G WeinshenkerAbstract:OBJECTIVE Elsberg syndrome (ES) is an established but often unrecognized cause of acute lumbosacral radiculitis with myelitis related to recent herpes virus infection. We defined ES, determined its frequency in patients with cauda equina syndrome (CES) with myelitis, and evaluated its clinical, radiologic, and microbiologic features and outcomes. METHODS We searched the Mayo Clinic medical records for ES and subsequently for combinations of index terms to identify patients with suspected CES and myelitis. RESULTS Our search yielded 30 patients, 2 diagnosed with ES and an additional 28 with clinical or radiologic evidence of CES retrospectively suspected of having ES. We classified patients in 5 groups according to diagnostic certainty. MRI and EMG confirmed that 2 had only myelitis, 5 only radiculitis, and 16 both. Two had preceding sacral herpes infection and 1 oral herpes simplex. Spinal cord lesions were commonly multiple, discontinuous, not expansile, and centrally or ventrally positioned. Lesions generally spared the distal conus. Nerve root enhancement was occasionally prominent and was smooth rather than nodular. Lymphocytic CSF pleocytosis was common. Thirteen patients (43%) had viral isolation studies, which were commonly delayed; the delay may have accounted for the low rate of viral detection. Acyclovir was administered to 6 patients. Most patients recovered with sequelae; 1 patient experienced encephalomyelitis and died. CONCLUSION ES is a definable condition likely responsible for 10% of patients with combined CES and myelitis. Radiologic findings are not entirely specific but may help in differentiating ES from some competing diagnostic considerations. We propose criteria to facilitate diagnosis.
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elsberg syndrome a rarely recognized cause of cauda equina syndrome and lower thoracic myelitis p2 074
Neurology, 2017Co-Authors: Filippo Savoldi, Timothy J Kaufmann, Eoin P Flanagan, Brian G WeinshenkerAbstract:Objective: To define Elsberg syndrome (ES), determine its frequency in patients with cauda equina syndrome (CES) with myelitis and evaluate its clinical, radiologic, microbiologic features and outcomes. Background: When accompanied by myelitis or in the setting of recent herpes virus infection, ES is an established but often unrecognized cause of acute lumbosacral radiculitis. Design/Methods: We searched the Mayo Clinic medical records from 2000 – 2016 for ES and subsequently for combinations of index terms to identify patients with suspected CES and myelitis. Results: Our search yielded 30 patients, 4 diagnosed with ES and an additional 26 patients with retrospectively suspect ES from among 337 patients with CES and suspected myelitis. We classified patients as lab-supported definite (LD, n=3), clinically definite (CD, n=9), probable (CPr, n=10) or possible (CPo, n=8) ES. All had clinically and/or radiologically proven CES. Based on MRI and EMG in 23 patients with adequate data 2 had only myelitis, 5 only radiculitis and 16 both. Two had preceding sacral herpes zoster and 1 oral herpes simplex. Spinal cord lesions were commonly multiple, discontinuous, not expansile, centrally or ventrally positioned and spared the distal conus. Nerve root enhancement was variably prominent, but not nodular. Lymphocytic CSF pleocytosis was common. Although CSF analysis was commonly performed, only thirteen patients (43%) were tested for viral infection; two tested positive for VZV in the CSF, one for HSV2 from a genital swab. Sample acquisition was commonly delayed possibly accounting for the low rate of demonstration of viral infection. Acyclovir was administered to 6 patients. Most patients recovered with sequelae and one patient experienced encephalomyelitis and died. Conclusions: ES is a definable condition likely responsible for 10% of patients with combined CES and myelitis. Radiologic findings are nonspecific but help differentiate ES from competing diagnostic considerations. We propose diagnostic criteria to facilitate diagnosis. Disclosure: Dr. Savoldi has nothing to disclose. Dr. Kaufmann has received personal compensation for activities with T.K. as a consultant. Dr. Flanagan has nothing to disclose. Dr. Weinshenker has received personal compensation for activities with Novartis, Mitsubishi Pharmaceuticals, Medimmune and Alexion Pharmaceuticals. Dr. Weinshenker has received (royalty or license fee or contractual rights) payments from RSR Ltd., Oxford University and MVZ Labor PD and Mayo Foundation.
Timothy J Kaufmann - One of the best experts on this subject based on the ideXlab platform.
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elsberg syndrome a rarely recognized cause of cauda equina syndrome and lower thoracic myelitis
Neuroimmunology and Neuroinflammation, 2017Co-Authors: Filippo Savoldi, Timothy J Kaufmann, Eoin P Flanagan, Michel Toledano, Brian G WeinshenkerAbstract:OBJECTIVE Elsberg syndrome (ES) is an established but often unrecognized cause of acute lumbosacral radiculitis with myelitis related to recent herpes virus infection. We defined ES, determined its frequency in patients with cauda equina syndrome (CES) with myelitis, and evaluated its clinical, radiologic, and microbiologic features and outcomes. METHODS We searched the Mayo Clinic medical records for ES and subsequently for combinations of index terms to identify patients with suspected CES and myelitis. RESULTS Our search yielded 30 patients, 2 diagnosed with ES and an additional 28 with clinical or radiologic evidence of CES retrospectively suspected of having ES. We classified patients in 5 groups according to diagnostic certainty. MRI and EMG confirmed that 2 had only myelitis, 5 only radiculitis, and 16 both. Two had preceding sacral herpes infection and 1 oral herpes simplex. Spinal cord lesions were commonly multiple, discontinuous, not expansile, and centrally or ventrally positioned. Lesions generally spared the distal conus. Nerve root enhancement was occasionally prominent and was smooth rather than nodular. Lymphocytic CSF pleocytosis was common. Thirteen patients (43%) had viral isolation studies, which were commonly delayed; the delay may have accounted for the low rate of viral detection. Acyclovir was administered to 6 patients. Most patients recovered with sequelae; 1 patient experienced encephalomyelitis and died. CONCLUSION ES is a definable condition likely responsible for 10% of patients with combined CES and myelitis. Radiologic findings are not entirely specific but may help in differentiating ES from some competing diagnostic considerations. We propose criteria to facilitate diagnosis.
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elsberg syndrome a rarely recognized cause of cauda equina syndrome and lower thoracic myelitis p2 074
Neurology, 2017Co-Authors: Filippo Savoldi, Timothy J Kaufmann, Eoin P Flanagan, Brian G WeinshenkerAbstract:Objective: To define Elsberg syndrome (ES), determine its frequency in patients with cauda equina syndrome (CES) with myelitis and evaluate its clinical, radiologic, microbiologic features and outcomes. Background: When accompanied by myelitis or in the setting of recent herpes virus infection, ES is an established but often unrecognized cause of acute lumbosacral radiculitis. Design/Methods: We searched the Mayo Clinic medical records from 2000 – 2016 for ES and subsequently for combinations of index terms to identify patients with suspected CES and myelitis. Results: Our search yielded 30 patients, 4 diagnosed with ES and an additional 26 patients with retrospectively suspect ES from among 337 patients with CES and suspected myelitis. We classified patients as lab-supported definite (LD, n=3), clinically definite (CD, n=9), probable (CPr, n=10) or possible (CPo, n=8) ES. All had clinically and/or radiologically proven CES. Based on MRI and EMG in 23 patients with adequate data 2 had only myelitis, 5 only radiculitis and 16 both. Two had preceding sacral herpes zoster and 1 oral herpes simplex. Spinal cord lesions were commonly multiple, discontinuous, not expansile, centrally or ventrally positioned and spared the distal conus. Nerve root enhancement was variably prominent, but not nodular. Lymphocytic CSF pleocytosis was common. Although CSF analysis was commonly performed, only thirteen patients (43%) were tested for viral infection; two tested positive for VZV in the CSF, one for HSV2 from a genital swab. Sample acquisition was commonly delayed possibly accounting for the low rate of demonstration of viral infection. Acyclovir was administered to 6 patients. Most patients recovered with sequelae and one patient experienced encephalomyelitis and died. Conclusions: ES is a definable condition likely responsible for 10% of patients with combined CES and myelitis. Radiologic findings are nonspecific but help differentiate ES from competing diagnostic considerations. We propose diagnostic criteria to facilitate diagnosis. Disclosure: Dr. Savoldi has nothing to disclose. Dr. Kaufmann has received personal compensation for activities with T.K. as a consultant. Dr. Flanagan has nothing to disclose. Dr. Weinshenker has received personal compensation for activities with Novartis, Mitsubishi Pharmaceuticals, Medimmune and Alexion Pharmaceuticals. Dr. Weinshenker has received (royalty or license fee or contractual rights) payments from RSR Ltd., Oxford University and MVZ Labor PD and Mayo Foundation.
