Cauda equina compression presenting as spontaneous priapism.

Abstract

SUMMARY Disturbance of autonomic function is an unusual feature of compression of the cauda equina. A 61 year old man who had complete occlusion of the lumbar spinal canal with compression of the cauda equina from a large centrally prolapsed disc, had spontaneous priapism, precipitated by walking and relieved by resting. This symptom was comparable to claudication by compression of cauda equina. It subsided completely after surgical removal of a prolapsed 1,4-5 disc.Compression of the cauda equina usually presents as pain in the lower back and legs. Symptoms are mostly related to position and exercise. Some patients develop immediate symptoms on standing up while others experience them after walking a certain distance. The syndrome is known as claudication from compression of the cauda equina (Dejerine, 191 1;Verbiest, 1954;Snyder et al., 1975

Cauda Equina Syndrome: presentation, outcome, and predictors with focus on micturition, defecation, and sexual dysfunction

“…The second patient presented with a numb feeling of the penis which had changed to priapism at follow-up after 7 weeks and after 5.5 months. Priapism as a feature of cauda equina compression is extremely uncommon and only two reports in literature describe such a case: one involves a 61-year-old man with a herniated disc at L4-L5 [24], the other a 60-year-old man with a degenerative stenosis at L3-L4 and lumbar arachnoiditis [25]. Both patients experienced priapism and a numb, respectively, a burning sensation at the saddle area when walking, without sphincter disturbances.…”

“…After decompression of the cauda equina, both patients experienced immediate and complete relieve of their symptoms, suggesting a causal relationship of cauda equina claudication and priapism. The parasympathetic fibers that are responsible for penile erection arise in S2-S4, and it is thought that their stimulation through (in these two cases: intermittent) compression had resulted in priapism [24]. To the authors' best knowledge, there are no case reports about priapism in nonintermittent cauda equina compression.…”

Lumbar spinal stenosis causing intermittent priapism

“…No evidence of a possible correlation between priapism and the duration of the disease and walking tolerance was noted. Four patients (3,5,6, and 7) complained of painful priapism when walking. The duration of the priapism varied from approximately 1 min to 3 min, but • (L3-4, L4-S) TENS = transcutaneous electrical nerve stimulation aMRI examined at L3-4 and LS-Sl levels before surgery and at follow-up; bMRI studied at L3-4 and LS-Sl levels before surgery and at follow-up; CCotrel-Dubousset transpedieular screw arrangement with posterolateral fusion Priapism in lumbar spinal stenosis H Babaetal Figure 2 Myelogram showing hour-glass stenosis at L3-4 and a total block at L4-5 in patient 3 had two-level lesions.…”

Ischaemic priapism: A clinical review

“…[10] Neurogenic Disorders (E.g. cauda equina, spinal cord injury) [11,12] Haematological Disorders (E.g. Sickle Cell Disease, thalassaemia) [10] Tumours [13] Medications (E.g.…”

“…[10] Common causes of priapism are summarised in Table 1. [1,[10][11][12][13][14][15] Diagnosis Diagnosis should be made as soon as possible after presentation; positive outcomes and future erectile function are closely related to the duration of tumescence. Often a diagnosis of priapism is self-evident and can be deduced from a brief history and examination.…”