Is scan‐negative cauda equina syndrome a functional neurological disorder? A pilot study

Gibson, Lucy; Harborow, Lucy; Nicholson, Timothy R; Bell, David A.; David, Anthony

doi:10.1111/ene.14182

Cited by 8 publications

(8 citation statements)

References 19 publications

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“…Around two-thirds of patients presenting with symptoms of sphincter dysfunction with or without leg weakness and pain have normal imaging or lumbar root changes that don't explain retention. 32,33 Patients with negative scans were found to commonly have positive features of FND, such as Hoover's sign. Factors such as pain, medications (particularly opiates) and pre-existing bladder disorders may all explain these common neurosurgical presentations.…”

Section: Urinary Retention and 'Scan-negative' Cauda Equina Syndromementioning

confidence: 99%

A practical review of functional neurological disorder (FND) for the general physician

Bennett

Diamond²,

Hoeritzauer

et al. 2021

Clinical Medicine

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We present a practical overview of functional neurological disorder (FND), its epidemiology, assessment and diagnosis, diagnostic pitfalls, treatment, aetiology and mechanism. We present an update on functional limb weakness, tremor, dystonia and other abnormal movements, dissociative seizures, functional cognitive symptoms and urinary retention, and 'scan-negative' cauda equina syndrome. The diagnosis of FND should rest on clear positive evidence, typically from a combination of physical signs on examination or the nature of seizures. In treatment of FND, clear communication of the diagnosis and the involvement of the multidisciplinary team is beneficial. We recommend that patients with FND are referred to specialists with expertise in neurological diagnosis. FND is a common presentation in emergency and acute medical settings and there are many practical elements to making a positive diagnosis and communication which are useful for all physicians to be familiar with.

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Section: Urinary Retention and 'Scan-negative' Cauda Equina Syndromementioning

confidence: 99%

A practical review of functional neurological disorder (FND) for the general physician

Bennett

Diamond²,

Hoeritzauer

et al. 2021

Clinical Medicine

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“…However, the frequency of co-morbid depression in a cohort of patients following surgery for CES has rarely been described; Gibson et al reported this to be present in only 8% (n = 2), whereas Hoeritzauer et al described a frequency of 22% (n = 17) in their study (whose population includes this present cohort) [8,20]. However, although the frequency of documented co-morbid psychiatric disorder was low in the Gibson study, it was higher (30%) when selfreporting.…”

Section: Discussionmentioning

confidence: 70%

Long-term mental wellbeing and functioning after surgery for cauda equina syndrome

et al. 2021

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Introduction Cauda Equina Syndrome (CES) can cause persisting life-changing dysfunction. There is scarce literature regarding the long-term assessment of CES symptoms, and rarer still is the impact of these symptoms on mental wellbeing investigated. This study assessed the long-term patient reported mental wellbeing outcomes of post-operative CES patients. Methods Patients who underwent surgery for CES between August 2013 and November 2014 were identified using an ethically approved database. They then completed validated questionnaires over the telephone assessing their mental and physical functioning (Short-Form 12 Questionnaire), generating the Physical Component Summary (PCS) and Mental Component Summary (MCS). Bladder, bowel and sexual function were also assessed using validated questionnaires. MCS scores were compared to both the Scottish mean and previously published cut-offs indicating patients at risk of depression. Correlations of MCS with bladder, bowel, sexual and physical dysfunction were examined and multifactorial regression to predict MCS from these variables analysed. Independent t-tests assessed the mean difference in MCS between patients presenting with incomplete CES (CES-I) and CES with retention (CES-R) and between those with radiologically confirmed and impending CES. Results Forty-six participants with a mean follow-up time of 43 months completed the study. The mean (±SD) MCS was 49 (±11.8) with 22% demonstrating poor mental health related quality of life in comparison to the Scottish mean. Overall, 37% had scores consistent with being at risk for depression with in the last 30 days, and 45% within the last 12 months. MCS was significantly correlated with Urinary Symptoms Profile (USP) score (-0.608), NBDS score (-0.556), ASEX score (-0.349) and PCS score (0.413) with worse bladder, bowel, sexual and physical dysfunction associated with worse MCS score. Multifactorial regression analysis demonstrated both urinary (USP score p = 0.031) and bowel function (NBDS score p = 0.009) to be significant predictive variables of mental health related quality of life. There were no significant mean differences in MCS between those presenting with CES-I and CES-R or those with radiologically complete and impending CES. Discussion This study demonstrates a high frequency of being at risk for depression in patients with CES and identifies outcome measures (physical, sexual and more so bladder and bowel dysfunction) associated with poorer mental wellbeing. Our large cohort and long follow-up highlight that CES patients should be considered at risk of depression, and the need to consider mental health outcomes following CES surgery.

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“…The presentation is primarily one of sphincter disturbance, but it is often accompanied by back pain, sciatica and sensorimotor symptoms in the legs. However, about two-thirds of patients presenting with suspected clinical cauda equina syndrome have no identifiable structural cause for their symptoms 3 4…”

Section: Neurological Disease Masquerading As a Surgical Problem?mentioning

confidence: 99%

“…From recent research in two different centres, only a few (2%–7%) patients end up having an alternative neurological problem causing their symptoms,3 4 and these are typically identified during the initial admission. The number of ‘late’ presentations of alternative neurological causes is much smaller.…”

Section: Neurological Disease Masquerading As a Surgical Problem?mentioning

confidence: 99%

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‘Scan-negative’ cauda equina syndrome: what to do when there is no neurosurgical cause

et al. 2021

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Suspected cauda equina syndrome is a common presentation in emergency departments, but most patients (≥70%) have no cauda equina compression on imaging. As neurologists become more involved with ‘front door’ neurology, referral rates of patients with these symptoms are increasing. A small proportion of patients without structural pathology have other neurological causes: we discuss the differential diagnosis and how to recognise these. New data on the clinical features of patients with ‘scan-negative’ cauda equina syndrome suggest that the symptoms are usually triggered by acute pain (with or without root impingement) causing changes in brain–bladder feedback in vulnerable individuals, exacerbated by medication and anxiety, and commonly presenting with features of functional neurological disorder.

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Is scan‐negative cauda equina syndrome a functional neurological disorder? A pilot study

Cited by 8 publications

References 19 publications

A practical review of functional neurological disorder (FND) for the general physician

A practical review of functional neurological disorder (FND) for the general physician

Long-term mental wellbeing and functioning after surgery for cauda equina syndrome

‘Scan-negative’ cauda equina syndrome: what to do when there is no neurosurgical cause

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