Benign transient urinary retention.

Abstract

SUMMARY Three cases of acute urinary retention due to sacral myeloradiculitis are described. The authors stress the importance of diagnosing this rare and benign condition, which, in the past, has too often been mislabelled as either psychogenic or the first manifestation of a demyelinating disease.Psychogenic disturbances have often been considered the most common cause of acute urinary retention when it occurs as an isolated sign in a young adult. On the other hand, it is sometimes considered as the first symptom of an important disease, such as multiple sclerosis. As they are rarely described in the neurological literature,' 2we present three cases of benign sacral myeloradiculitis and stress the importance of not overlooking minor symptoms and signs such as transient paraesthesiae and small areas of hypaesthesiae. Case reportsCase 1 A 32 year old man suddenly noticed penile paraesthesiae. Two days later, he developed a cough and fever (38°C). On the fourth day he developed acute retention of urine with constipation and decreased potency. He also complained of paraesthesiae in the outer borders of both feet. He had no relevant past history and in particular, no history of previous disturbances of micturition or diabetes. On admission the same day, the general physical and urological examinations were normal apart from retention. No herpetic vesicles were noted. The only neurological abnormality was reduced and asymmetrical ankle reflexes. Cystoscopy revealed a large but otherwise normal bladder. At gas cystometry, the raise of intravesical pressure with increased bladder filling was normal. Urethral pressure profile and electromyography of the external sphincter were not per- constipated. There was no relevant past history. The external urogenital tract was normal apart from a vulvar mycotic infection. The only neurological abnormality was reduced sensation over the outer border of the left foot. Cystoscopy showed reduced mobility of the bladder neck during efforts to start voiding. Intravenous urography and gas cystometry were normal. Urethral pressure profile and electromyography of the external urethral sphincter were not performed. CSF contained 24 white blood cells/mm3, with 71% lymphocytes. Total protein was 0-6 g/l. CSF VDRL and protein electrophoresis were normal. Viral studies revealed fluorescent antibodies to herpes I and II decreasing from 1/320 (day 2) to 1/80 (day 26). The complement fixation test remained within normal limits, both in serum and CSF. After 10 days, the patient was able to pass urine normally. The patient has remained asymptomatic for 4 years. Case 3 A 27 year old woman, a ski champion, had a one month history of rhinorrhoea, non productive cough and lassitude without fever. Six days before admission she noticed paraesthesiae in both buttocks. Two days before admission, she developed painful difficulty in passing urine, and on admission she was in retention. Gynaecological, neurological, as well as general examinations were normal. Cystoscopy was normal. Water cystometry showed a...

Acute Urinary Retention as an Unusual Manifestation of Aseptic Meningitis.

“…5 (May 2002) ( 1 , 2). In cases of isolated myeloradiculitis, the concurrent neurological symptomsand signs are often mild, transient, or even absent (1,13), and, so far as we could determine, CSF pleocytosis is not greater than 100 cells/mm3 in most of the reported cases (1, 2, 12, 13). While our case is compatible with this syndrome, the patient's high fever accompanied by mild headache, a sign of meningeal irritation, and relatively high degree of lymphocytic CSF pleocytosis (370 cells/mm3) also suggest the presence of aseptic meningitis as a preceding infection.…”

“…It is therefore advisable to duly inform patients of the favorable outcomeof neurogenic bladder, since they, especially when young, worry about prolonged urinary retention and tend to suffer from stress resulting from intermittent self-catheterization (8), as in our case. As the cause of neurogenic bladder associated with aseptic meningitis, either sacral myeloradiculitis due to a direct viral inflammation (1,5,(10)(11)(12) or a process of post-infectious inflammatory demyelination in the peripheral and/or central nervous system (3, 1 1, 12) has been postulated. The combination of acute urinary retention and CSFpleocytosis is knownas Elsberg syndrome (1 , 2).…”

“…Acute urinary retention with pleocytosis in the cerebrospinal fluid (CSF), known as the Elsberg syndrome (1,2), is encountered infrequently and specifically in healthy young adults (1)(2)(3)(4)(5)(6)(7)(8). In most of such cases, this disorder is ascribed to a sacral myeloradiculitis of viral origin (1)(2)(3)(4)(5)(6)(7)(8).…”

“…In most of such cases, this disorder is ascribed to a sacral myeloradiculitis of viral origin (1)(2)(3)(4)(5)(6)(7)(8). On the other hand, diagnosis of viral or aseptic meningitis is not always easy, since its typical symptomsor identifiable neurological signs are often mild or even absent (3,9).…”

Elsberg Syndrome with Eosinophilic Meningoencephalitis Caused by Angiostrongylus cantonensis

“…3). 3 (12). In summary, we described a case of eosinophilic meningoencephalitis with Elsberg syndrome.…”