Park Chan-Hee, Park Eunhee, Jung Tae-Du
Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Korea.
Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Korea.
Healthcare (Basel). 2021 Oct 14;9(10):1370. doi: 10.3390/healthcare9101370.
: Typical cauda equina syndrome (CES) presents as low back pain, bilateral leg pain with motor and sensory deficits, genitourinary dysfunction, saddle anesthesia and fecal incontinence. In addition, it is a neurosurgical emergency, which is essential to diagnose as soon as possible, and needs prompt intervention. However, unilateral CES is rare. Here, we report a unique case of a patient who had unilateral symptoms of CES due to cancer metastasis and was diagnosed through electromyography. : A 71-year-old man with diffuse large B cell lymphoma (DLBCL) suffered from severe pain, motor weakness in the right lower limb and urinary incontinence, and hemi-saddle anesthesia. It was easy to be confused with lumbar radiculopathy due to the unilateral symptoms. Lumbar spine magnetic resonance imaging (MRI) showed suspected multifocal bone metastasis in the TL spine, including T11-L5, the bilateral sacrum and iliac bones, and suspected epidural metastasis at L4/5, L5/S1 and the sacrum. PET CT conducted after the third R-CHOP showed residual hypermetabolic lesions in L5, the sacrum, and the right presacral area. : Nerve conduction studies (NCS) revealed peripheral neuropathy in both hands and feet. Electromyography (EMG) presented abnormal results indicating development of muscle membrane instability following neural injury, not only on the right symptomatic side, but also on the other side which was considered intact. Overall, he was diagnosed with cauda equina syndrome caused by DLBCL metastasis, and referred to neurosurgical department. : Early diagnosis of unilateral CES may go unnoticed due to its unilateral symptoms. Failure to perform the intervention at the proper time can impede recovery and leave permanent complications. Therefore, physicians need to know not only the typical CES, but also the clinical features of atypical CES when encountering a patient, and further evaluation such as electrodiagnostic study or lumbar spine MRI have to be considered.
典型的马尾综合征（CES）表现为腰痛、双侧腿痛伴运动和感觉功能障碍、泌尿生殖功能障碍、鞍区麻木和大便失禁。此外，它是一种神经外科急症，必须尽快诊断，并需要及时干预。然而，单侧马尾综合征很少见。在此，我们报告一例因癌症转移导致单侧马尾综合征症状的独特病例，并通过肌电图进行了诊断。：一名71岁弥漫性大B细胞淋巴瘤（DLBCL）男性患者，出现严重疼痛、右下肢运动无力、尿失禁和半鞍区麻木。由于症状单侧性，很容易与腰椎神经根病混淆。腰椎磁共振成像（MRI）显示胸腰段脊柱疑似多灶性骨转移，包括T11 - L5、双侧骶骨和髂骨，以及L4/5、L5/S1和骶骨处疑似硬膜外转移。第三次R - CHOP化疗后进行的PET CT显示L5、骶骨和右骶前区有残留的高代谢病变。：神经传导研究（NCS）显示双手和双足周围神经病变。肌电图（EMG）结果异常，表明神经损伤后肌肉膜不稳定，不仅在有症状的右侧，在另一侧被认为正常的部位也是如此。总体而言，他被诊断为DLBCL转移导致的马尾综合征，并转诊至神经外科。：单侧CES由于其单侧症状可能早期未被注意到。未能在适当时间干预的失败会阻碍恢复并留下永久性并发症。因此，医生在接诊患者时不仅要了解典型的CES，还要了解非典型CES的临床特征，并考虑进行进一步评估，如电诊断研究或腰椎MRI检查。
