Elsberg syndrome: radiculomyelopathy and acute urinary retention in patient with genital herpes

Abstract

We describe a case of a sexually active woman who presented acute urinary retention associated with herpes genitalis infection and with few other neurological signs. The outcome of the disease was positive. We stress the utility of a careful CSF examination.

Meningitis–retention syndrome

“…An underactive detrusor originates from various sites of lesions in the neural axis, with lower motor neuron lesions being the most common. Elsberg syndrome (infectious sacral polyradiculitis) is such a disease, causing an underactive detrusor with minimal neurological abnormalities, i. e., pain, hypalgesia and skin eruption in the sacral dermatomes [11,12,13,14].CSF abnormalities may also occur, although meningeal irritation such as headache is not a feature of this disease [12,14]. The causes of this disease are mostly viral, particularly HSV and VZV infections (genital herpes) [12][13][14].…”

Acute urinary retention due to benign inflammatory nervous diseases

“…Recently the term ''Elsberg syndrome'' has been occasionally used, which is rather vaguely assigned to sacral myeloradiculitis of undetermined etiology [25,26], sacral herpes [7,23,46,47,48,49], sacral vasculitic neuropathy [50], possible MRS [35], possible ADEM [32,33], or conus infarction [51]. According to the textbook 26 in which the term ''Elsberg syndrome'' first appeared:…”

Urinary retention for the neurologist

“…Some patients, usually young women, who develop acute onset of urinary retention with impaired perianal sensation and a CSF lymphocytic pleocytosis, have herpes simplex (usually type 2) or varicella zoster infection on PCR 14. This is ‘Elsberg's syndrome’, although the original cases from 100 years ago probably had many different causes, and so were quite different from cases for which we use the term today 15…”