RT Journal Article
SR Electronic
T1 Scan-Negative Cauda Equina Syndrome
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP e433
OP e447
DO 10.1212/WNL.0000000000011154
VO 96
IS 3
A1 Ingrid Hoeritzauer
A1 Alan Carson
A1 Patrick Statham
A1 Jalesh N. Panicker
A1 Voula Granitsiotis
A1 Maria Eugenicos
A1 David Summers
A1 Andreas K. Demetriades
A1 Jon Stone
YR 2021
UL http://n.neurology.org/content/96/3/e433.abstract
AB 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 < 0.0001), were more likely to describe their current back pain as worst ever (41% vs 46% and 70%, p = 0.005), and were more likely to 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.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.ACE=Adverse Childhood Experiences; ASEX=Arizona Sexual Experiences Questionnaire; AVM=arteriovenous malformation; CES=cauda equina syndrome; CI=confidence interval; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, 4th edition; DSM-5=Diagnostic and Statistical Manual of Mental Disorders, 5th edition; FND=functional neurologic disorder; HADS=Hospital Anxiety and Depression Scale; NBDS=Neurogenic Bowel Dysfunction Score; OR=odds ratio; PHQ-15=Patient Health Questionnaire Somatic Symptom Severity Score; PTSD=posttraumatic stress disorder; RR=relative risk; SF-12=Short Form–12; USP=Urinary Symptom Profile; WSAS=Work and Social Adjustment Scale