Pace-Patterson Alyssa M, Mirza Tuba S, Payne-Johnson Ann I
Research, Alabama College of Osteopathic Medicine, Pensacola, USA.
Family Medicine, Bariatric Medicine-Non Surgical Weight Loss Care, Ascension Sacred Heart, Pensacola, USA.
Cureus. 2021 Mar 23;13(3):e14056. doi: 10.7759/cureus.14056.
Cauda equina syndrome (CES) is a rare neurological emergency that requires prompt diagnosis and immediate surgical intervention for the best potential patient outcome. CES results from the compression of spinal roots along the lower spine usually at the level of L2 or below. It typically presents with severe low back pain, pain radiating to lower extremities, motor weakness, sensory loss, saddle anesthesia, bladder and bowel dysfunction. It is most commonly caused by a large central intervertebral disc herniation or central canal spinal stenosis but can also occur on occasion from abscesses, neoplasms, and inflammatory conditions. If the patient's symptoms are overlooked and surgical intervention is delayed there is a risk for long-term damage to neurological function. Here, we will present a case of a 46-year-old female with a long-standing history of back pain that presented to her primary care office with worsening back pain symptoms as well as a new presentation of urinary incontinence. A prompt MRI confirmed CES and the patient was advised to report to the nearest ED. At the hospital, neurosurgeons performed a laminectomy and found a mass along L3 that was compressing the cauda equina and associated nerve roots. The pathology of the mass revealed an extramedullary plasmacytoma (EMP) that was later determined to originate from the right psoas muscle. The case provides insight into the patient's presentation of CES and the key differentiating factors that led the medical care team to order the appropriate work up and prevent the long-term complications associated with an untreated CES.
马尾综合征（CES）是一种罕见的神经急症，需要迅速诊断并立即进行手术干预，以实现最佳的患者预后。CES是由下脊柱水平（通常在L2或更低水平）的脊神经根受压引起的。其典型表现为严重的下背痛、向下肢放射的疼痛、运动无力、感觉丧失、鞍区麻醉、膀胱和肠道功能障碍。最常见的病因是巨大的中央型椎间盘突出或中央管狭窄，但偶尔也可由脓肿、肿瘤和炎症性疾病引起。如果患者的症状被忽视且手术干预延迟，存在神经功能长期受损的风险。在此，我们将介绍一例46岁女性患者，她有长期的背痛病史，因背痛症状加重以及新出现的尿失禁症状前往其初级保健诊所就诊。迅速进行的磁共振成像（MRI）证实为CES，建议患者前往最近的急诊室（ED）。在医院，神经外科医生进行了椎板切除术，发现L3处有一个肿块压迫马尾和相关神经根。肿块的病理检查显示为髓外浆细胞瘤（EMP），后来确定起源于右腰大肌。该病例有助于深入了解患者的CES表现以及促使医疗团队进行适当检查并预防与未经治疗的CES相关的长期并发症的关键鉴别因素。
