Impact of MR Neurography in Patients with Chronic Cauda Equina Syndrome Presenting as Chronic Pelvic Pain and Dysfunction

Petrasic, Jason; Chhabra, Avneesh; Scott, Kelly M.

doi:10.3174/ajnr.a4994

Cited by 13 publications

(7 citation statements)

References 16 publications

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“…Diagnosis should be based on histopathological findings because the presence of spinal nerve root fibers in the wall or cavity of the cyst are required for confirmation. However, magnetic resonance neurography has been recently proposed for diagnosis [7]. In our case, histopathology was not performed because non-surgical treatment was effective in relieving the associated neuralgia; but, results of the imaging studies supported our diagnosis.…”

Section: Discussionmentioning

confidence: 60%

Atypical findings of perineural cysts on postmyelographic computed tomography: a case report of intermittent intercostal neuralgia caused by thoracic perineural cysts

et al. 2017

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BackgroundPerineural cysts are sometimes found incidentally with magnetic resonance imaging, and clinical symptoms requiring treatment are rare. Perineural cysts typically exhibit delayed filling with contrast medium on myelography, which is one of the criteria used by Tarlov to distinguish perineural cysts from meningeal diverticula. We present a case of multiple thoracolumbar perineural cysts, one of which was considered the cause of intermittent intercostal neuralgia with atypical findings on postmyelographic computed tomography seen as selective filling of contrast medium.Case presentationA 61-year-old woman presented with intermittent pain on her left chest wall with distribution of the pain corresponding to the T10 dermatome. Magnetic resonance imaging showed multiple thoracolumbar perineural cysts with the largest located at the left T10 nerve root. On postmyelographic computed tomography immediately after contrast medium injection, the largest cyst and another at left T9 showed selective filling of contrast medium, suggesting that inflow of cerebrospinal fluid to the cyst exceeded outflow. Three hours after the injection, the intensity of the cysts was similar to the intensity of the thecal sac, and by the next day, contrast enhancement was undetectable. The patient was treated with an intercostal nerve block at T10, and the pain subsided. However, after 9 months of observation, the neuralgia recurred, and the nerve block was repeated with good effect. There was no recurrence 22 months after the last nerve block.ConclusionsWe concluded that intermittent elevation of cerebrospinal fluid pressure in the cyst caused the neuralgia because of an imbalance between cerebrospinal fluid inflow and outflow, and repeated intercostal nerve blocks resolved the neuralgia. Our case demonstrates the mechanism of cyst expansion.

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Section: Discussionmentioning

confidence: 60%

Atypical findings of perineural cysts on postmyelographic computed tomography: a case report of intermittent intercostal neuralgia caused by thoracic perineural cysts

et al. 2017

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“…Acute or sub-acute compressive CES is a surgical emergency. With the recognition of DLMs, much literature will have to be revised appropriately [960][961][962][963]. Chronic CES from iatrogenic LMF is very distressing to patients, particularly those moving in and out of bowel and bladder sphincter control with disease fluctuation, but is not a surgical emergency [963,964] unless there is colonic atonia and the patient is in danger of ruptured bowel, or a similar life threatening condition-in which case the condition is the emergency, not the cauda equina.…”

Section: Is Chronic Cauda Equina Syndrome (Ces) From Dlms ± Flare Con...mentioning

confidence: 99%

“…Results of recent use of intra-SAS neuroendoscopic lysis of adhesions are awaited. Educational emergency "self-help plans," appropriate supplies (self-catheter for urine, gloves for manual stool removal), training on how to use them, and a steroid pack if they respond to steroids helps patients manage at home [961,963,965].…”

Section: Plos Onementioning

confidence: 99%

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Palackdkharry¹,

Wottrich²,

Dienes³

et al. 2022

PLoS ONE

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Background & importance This patient and public-involved systematic review originally focused on arachnoiditis, a supposedly rare “iatrogenic chronic meningitis” causing permanent neurologic damage and intractable pain. We sought to prove disease existence, causation, symptoms, and inform future directions. After 63 terms for the same pathology were found, the study was renamed Diseases of the Leptomeninges (DLMs). We present results that nullify traditional clinical thinking about DLMs, answer study questions, and create a unified path forward. Methods The prospective PRISMA protocol is published at Arcsology.org. We used four platforms, 10 sources, extraction software, and critical review with ≥2 researchers at each phase. All human sources to 12/6/2020 were eligible for qualitative synthesis utilizing R. Weekly updates since cutoff strengthen conclusions. Results Included were 887/14286 sources containing 12721 DLMs patients. Pathology involves the subarachnoid space (SAS) and pia. DLMs occurred in all countries as a contributor to the top 10 causes of disability-adjusted life years lost, with communicable diseases (CDs) predominating. In the USA, the ratio of CDs to iatrogenic causes is 2.4:1, contradicting arachnoiditis literature. Spinal fusion surgery comprised 54.7% of the iatrogenic category, with rhBMP-2 resulting in 2.4x more DLMs than no use (p<0.0001). Spinal injections and neuraxial anesthesia procedures cause 1.1%, and 0.2% permanent DLMs, respectively. Syringomyelia, hydrocephalus, and arachnoid cysts are complications caused by blocked CSF flow. CNS neuron death occurs due to insufficient arterial supply from compromised vasculature and nerves traversing the SAS. Contrast MRI is currently the diagnostic test of choice. Lack of radiologist recognition is problematic. Discussion & conclusion DLMs are common. The LM clinically functions as an organ with critical CNS-sustaining roles involving the SAS-pia structure, enclosed cells, lymphatics, and biologic pathways. Cases involve all specialties. Causes are numerous, symptoms predictable, and outcomes dependent on time to treatment and extent of residual SAS damage. An international disease classification and possible treatment trials are proposed.

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“…Fortunately, a growing number of clinical studies are published, recently. These studies showed promising results that the MRN played an important role in diagnostic certainty and treatment decision-making ( 46 47 49 51 52 ). However, most of the studies were retrospective, and inevitably biased to positive side.…”

Section: Discussionmentioning

confidence: 99%

Role of MR Neurography for Evaluation of the Lumbosacral Plexus: A Scoping Review

Kim¹,

Jung²

2022

J Korean Soc Radiol

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Purpose MR neurography (MRN) is an imaging technique optimized to visualize the peripheral nerves. This review aimed to discover an optimized protocol for MRN of the lumbosacral plexus (LSP) and identify evidence for the clinical benefit of lumbosacral plexopathies. Materials and Methods We performed a systematic search of the two medical databases until September 2021. ‘Magnetic resonance imaging’, ‘lumbosacral plexus’, ‘neurologic disease’, or equivalent terms were used to search the literature. We extracted information on indications, MRN protocols for LSP, and clinical efficacy from 55 studies among those searched. Results MRN of the LSP is useful for displaying the distribution of peripheral nerve disease, guiding perineural injections, and assessing extraspinal causes of sciatica. Three-dimensional short-tau inversion recovery turbo spin-echo combined with vascular suppression is the mainstay of MRN. Conclusion Future work on the MRN of LSP should be directed to technical maturation and clinical validation of efficacy.

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Impact of MR Neurography in Patients with Chronic Cauda Equina Syndrome Presenting as Chronic Pelvic Pain and Dysfunction

Abstract: MR neurography impacts the diagnosis and therapeutic management of patients with suspected chronic cauda equina syndrome.

Cited by 13 publications

References 16 publications

Atypical findings of perineural cysts on postmyelographic computed tomography: a case report of intermittent intercostal neuralgia caused by thoracic perineural cysts

Atypical findings of perineural cysts on postmyelographic computed tomography: a case report of intermittent intercostal neuralgia caused by thoracic perineural cysts

The leptomeninges as a critical organ for normal CNS development and function: First patient and public involved systematic review of arachnoiditis (chronic meningitis)

Role of MR Neurography for Evaluation of the Lumbosacral Plexus: A Scoping Review

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